| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
184 |
179 |
$7K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
45 |
44 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
95 |
95 |
$1K |
| 3008F |
|
77 |
77 |
$760.00 |
| 92551 |
|
59 |
59 |
$736.92 |
| 83655 |
|
31 |
31 |
$510.57 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
25 |
24 |
$408.00 |
| 81002 |
|
67 |
67 |
$229.89 |
| 85018 |
|
49 |
49 |
$155.24 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
14 |
14 |
$120.82 |
| 36416 |
|
33 |
33 |
$99.99 |