| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
737 |
523 |
$57K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
806 |
683 |
$56K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,029 |
927 |
$54K |
| 90677 |
|
404 |
351 |
$29K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
165 |
154 |
$12K |
| 90698 |
|
616 |
498 |
$10K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
515 |
425 |
$9K |
| 90680 |
|
381 |
327 |
$6K |
| 90686 |
|
291 |
239 |
$5K |
| 90744 |
|
275 |
234 |
$5K |
| D1206 |
Topical application of fluoride varnish |
167 |
98 |
$4K |
| 90633 |
|
266 |
187 |
$4K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
48 |
41 |
$4K |
| 96127 |
|
117 |
108 |
$3K |
| 90710 |
|
162 |
110 |
$3K |
| 90670 |
|
136 |
136 |
$2K |
| 83655 |
|
98 |
61 |
$1K |
| 90656 |
|
48 |
48 |
$802.08 |
| 90661 |
|
46 |
45 |
$785.37 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
59 |
57 |
$650.29 |
| 90651 |
|
34 |
27 |
$568.14 |
| 85018 |
|
114 |
69 |
$264.84 |
| 90619 |
|
12 |
12 |
$200.52 |
| 36416 |
|
12 |
12 |
$49.20 |