| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
19,006 |
14,645 |
$916K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
2,693 |
2,197 |
$196K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
2,365 |
1,803 |
$178K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
2,052 |
1,758 |
$164K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
1,458 |
1,103 |
$98K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
3,343 |
2,636 |
$53K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,255 |
1,040 |
$32K |
| 36416 |
|
6,892 |
5,694 |
$27K |
| 90686 |
|
2,323 |
1,833 |
$23K |
| 90670 |
|
1,199 |
935 |
$23K |
| 99402 |
|
742 |
488 |
$19K |
| 83655 |
|
1,497 |
1,145 |
$17K |
| 85018 |
|
7,112 |
5,732 |
$17K |
| 0071A |
|
321 |
188 |
$14K |
| D1206 |
Topical application of fluoride varnish |
496 |
360 |
$13K |
| 90651 |
|
548 |
399 |
$12K |
| 90671 |
|
122 |
76 |
$12K |
| 90734 |
|
585 |
398 |
$10K |
| 90716 |
|
603 |
445 |
$9K |
| 0072A |
|
217 |
152 |
$9K |
| 96127 |
|
609 |
524 |
$9K |
| 90707 |
|
582 |
424 |
$7K |
| 90648 |
|
665 |
501 |
$7K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
58 |
51 |
$5K |
| 90715 |
|
393 |
289 |
$5K |
| 96111 |
|
368 |
310 |
$4K |
| 90619 |
|
221 |
210 |
$4K |
| 90680 |
|
251 |
209 |
$4K |
| 90633 |
|
313 |
245 |
$3K |
| 99384 |
|
24 |
14 |
$2K |
| 90658 |
|
99 |
83 |
$2K |
| 96112 |
|
73 |
57 |
$2K |
| 90723 |
|
58 |
49 |
$858.54 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
12 |
12 |
$837.24 |
| 90660 |
|
35 |
30 |
$607.17 |
| 90698 |
|
43 |
40 |
$536.47 |
| 90696 |
|
73 |
51 |
$460.80 |
| 90700 |
|
45 |
25 |
$411.72 |
| 91320 |
|
14 |
13 |
$233.94 |
| 91307 |
|
344 |
187 |
$0.28 |