| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,751 |
1,228 |
$118K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
769 |
462 |
$60K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
281 |
232 |
$28K |
| 92552 |
|
1,299 |
1,031 |
$27K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
248 |
219 |
$24K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
1,275 |
1,105 |
$13K |
| 90686 |
|
617 |
534 |
$12K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
87 |
82 |
$8K |
| 96127 |
|
1,043 |
762 |
$7K |
| 99173 |
|
1,285 |
1,027 |
$3K |
| 0001A |
|
52 |
45 |
$2K |
| 0002A |
|
39 |
36 |
$1K |
| 99383 |
|
13 |
13 |
$1K |
| 90619 |
|
23 |
17 |
$456.08 |
| 90651 |
|
20 |
18 |
$404.36 |
| D1206 |
Topical application of fluoride varnish |
14 |
14 |
$348.88 |
| 90620 |
|
13 |
12 |
$302.64 |
| 91300 |
|
66 |
53 |
$0.00 |