| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
687 |
640 |
$38K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
173 |
164 |
$4K |
| 92552 |
|
130 |
124 |
$3K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
33 |
33 |
$3K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
12 |
12 |
$850.80 |
| D0145 |
Oral evaluation for a patient under three years of age |
17 |
17 |
$518.08 |
| D1206 |
Topical application of fluoride varnish |
17 |
17 |
$342.72 |
| 99173 |
|
137 |
131 |
$238.53 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
17 |
17 |
$111.69 |
| 96127 |
|
24 |
24 |
$32.98 |