| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,678 |
1,358 |
$54K |
| 83655 |
|
418 |
344 |
$6K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
90 |
63 |
$3K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
53 |
47 |
$3K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
223 |
201 |
$2K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
28 |
28 |
$2K |
| 99460 |
|
17 |
14 |
$1K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
49 |
44 |
$1K |
| 90658 |
|
114 |
108 |
$1K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
17 |
15 |
$846.15 |
| 85018 |
|
318 |
253 |
$787.54 |
| D1206 |
Topical application of fluoride varnish |
29 |
28 |
$518.70 |
| 90685 |
|
31 |
27 |
$248.56 |
| 90670 |
|
13 |
12 |
$114.72 |
| 90686 |
|
14 |
12 |
$114.72 |