| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,074 |
991 |
$50K |
| D1206 |
Topical application of fluoride varnish |
309 |
307 |
$16K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
208 |
199 |
$14K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
194 |
194 |
$13K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
369 |
328 |
$10K |
| G0447 |
Face-to-face behavioral counseling for obesity, 15 minutes |
246 |
228 |
$8K |
| 92015 |
Determination of refractive state |
143 |
143 |
$8K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
94 |
94 |
$7K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
57 |
57 |
$4K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
245 |
240 |
$3K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
119 |
115 |
$3K |
| 99401 |
|
123 |
123 |
$3K |
| 99188 |
|
133 |
133 |
$2K |
| 92567 |
|
155 |
133 |
$1K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
44 |
44 |
$1K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
18 |
15 |
$1K |
| 92587 |
|
108 |
108 |
$1K |
| 87999 |
|
263 |
257 |
$904.20 |
| 99177 |
|
85 |
70 |
$868.00 |
| 99058 |
|
48 |
48 |
$770.85 |
| 96127 |
|
126 |
126 |
$478.39 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
33 |
33 |
$219.20 |
| 90651 |
|
13 |
13 |
$208.85 |
| 83655 |
|
14 |
14 |
$166.82 |
| 36416 |
|
89 |
82 |
$119.60 |
| 85018 |
|
29 |
29 |
$68.40 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
28 |
27 |
$65.76 |
| S9470 |
Nutritional counseling, dietitian visit |
232 |
219 |
$0.00 |
| 99051 |
|
19 |
17 |
$0.00 |
| S9451 |
Exercise classes, non-physician provider, per session |
233 |
219 |
$0.00 |
| 90686 |
|
39 |
39 |
$0.00 |
| 90688 |
|
91 |
91 |
$0.00 |