| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
11,124 |
10,299 |
$162K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
2,769 |
2,766 |
$95K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
2,627 |
2,607 |
$75K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
2,424 |
2,397 |
$69K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
1,715 |
1,692 |
$68K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
1,791 |
1,771 |
$62K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
567 |
549 |
$47K |
| 92552 |
|
6,045 |
6,031 |
$29K |
| G9920 |
Screening performed and negative |
1,230 |
1,226 |
$23K |
| 85018 |
|
6,997 |
6,968 |
$8K |
| 90670 |
|
1,908 |
1,902 |
$7K |
| 90698 |
|
1,380 |
1,378 |
$6K |
| 90680 |
|
1,107 |
1,106 |
$5K |
| 99462 |
|
211 |
93 |
$5K |
| 90744 |
|
838 |
835 |
$5K |
| 92081 |
|
5,004 |
4,991 |
$5K |
| 99460 |
|
67 |
67 |
$3K |
| 90686 |
|
1,149 |
1,148 |
$3K |
| 90633 |
|
918 |
913 |
$3K |
| 99381 |
|
19 |
19 |
$2K |
| 81003 |
|
4,184 |
4,168 |
$2K |
| 90649 |
|
764 |
763 |
$2K |
| D1206 |
Topical application of fluoride varnish |
309 |
291 |
$2K |
| 90734 |
|
742 |
741 |
$1K |
| 90707 |
|
270 |
270 |
$1K |
| 90716 |
|
263 |
262 |
$943.44 |
| 90671 |
|
136 |
136 |
$937.00 |
| 90715 |
|
283 |
283 |
$925.20 |
| 86580 |
|
469 |
461 |
$799.83 |
| 90700 |
|
226 |
225 |
$774.00 |
| 99383 |
|
12 |
12 |
$609.18 |
| 90648 |
|
173 |
172 |
$586.00 |
| 90696 |
|
133 |
133 |
$523.00 |
| 90710 |
|
164 |
162 |
$474.09 |
| 81002 |
|
255 |
253 |
$416.81 |
| 90651 |
|
140 |
140 |
$321.00 |
| 90620 |
|
211 |
211 |
$212.60 |
| 90697 |
|
46 |
46 |
$153.00 |
| 90713 |
|
28 |
27 |
$132.00 |
| 87070 |
|
111 |
111 |
$125.94 |
| 90657 |
|
103 |
103 |
$112.42 |
| 90619 |
|
27 |
27 |
$100.00 |
| 90621 |
|
39 |
39 |
$98.00 |