| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92551 |
|
2,697 |
2,697 |
$29K |
| D1206 |
Topical application of fluoride varnish |
1,069 |
1,069 |
$9K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
3,892 |
3,763 |
$3K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
758 |
758 |
$1K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
938 |
882 |
$971.72 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
936 |
936 |
$934.07 |
| G9920 |
Screening performed and negative |
2,984 |
2,984 |
$832.59 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
1,075 |
1,075 |
$403.74 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
682 |
682 |
$347.98 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
12 |
12 |
$81.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
118 |
118 |
$59.40 |
| 99188 |
|
31 |
31 |
$35.64 |
| 90716 |
|
64 |
64 |
$0.00 |
| 1036F |
|
839 |
839 |
$0.00 |
| 90619 |
|
55 |
55 |
$0.00 |
| 90686 |
|
608 |
607 |
$0.00 |
| 90620 |
|
27 |
27 |
$0.00 |
| 90651 |
|
200 |
199 |
$0.00 |
| 90723 |
|
13 |
13 |
$0.00 |
| 90461 |
|
24 |
24 |
$0.00 |
| 90670 |
|
78 |
78 |
$0.00 |
| 90648 |
|
65 |
65 |
$0.00 |
| 90734 |
|
52 |
52 |
$0.00 |
| 90707 |
|
52 |
52 |
$0.00 |
| 90633 |
|
44 |
44 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
54 |
54 |
$0.00 |
| G8431 |
Screening for depression is documented as being positive and a follow-up plan is documented |
12 |
12 |
$0.00 |