| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
910 |
856 |
$63K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
821 |
796 |
$52K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
730 |
716 |
$51K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
657 |
652 |
$47K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
971 |
938 |
$41K |
| 92551 |
|
1,146 |
1,132 |
$39K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
290 |
287 |
$21K |
| 90700 |
|
870 |
849 |
$15K |
| 99215 |
Prolong outpt/office vis |
154 |
151 |
$14K |
| 83655 |
|
622 |
613 |
$8K |
| 90686 |
|
1,078 |
1,050 |
$6K |
| 85013 |
|
817 |
805 |
$5K |
| 90713 |
|
716 |
702 |
$4K |
| 90648 |
|
664 |
648 |
$4K |
| 90670 |
|
662 |
645 |
$4K |
| 90707 |
|
203 |
195 |
$3K |
| 90651 |
|
423 |
419 |
$2K |
| 90680 |
|
405 |
392 |
$2K |
| 90744 |
|
236 |
225 |
$1K |
| 81002 |
|
414 |
402 |
$1K |
| 90716 |
|
199 |
191 |
$1K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
39 |
38 |
$1K |
| 90633 |
|
134 |
132 |
$773.48 |
| D1206 |
Topical application of fluoride varnish |
29 |
29 |
$459.94 |
| 99051 |
|
31 |
31 |
$361.98 |
| 94010 |
|
14 |
14 |
$326.62 |
| 90734 |
|
52 |
50 |
$291.38 |
| 90715 |
|
12 |
12 |
$209.35 |
| 94664 |
|
12 |
12 |
$179.16 |
| 0071A |
|
19 |
17 |
$0.00 |
| 0074A |
|
12 |
12 |
$0.00 |