| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,216 |
2,026 |
$221K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,508 |
2,209 |
$162K |
| 99215 |
Prolong outpt/office vis |
691 |
657 |
$97K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
2,008 |
1,888 |
$62K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,031 |
916 |
$37K |
| 99401 |
|
655 |
603 |
$21K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
156 |
148 |
$15K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
147 |
142 |
$15K |
| 92567 |
|
883 |
797 |
$11K |
| 99173 |
|
1,403 |
1,289 |
$9K |
| 96127 |
|
452 |
413 |
$7K |
| 92551 |
|
1,233 |
1,130 |
$7K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
32 |
27 |
$3K |
| 87811 |
Infectious agent antigen detection by immunoassay; SARS-CoV-2 (COVID-19) |
31 |
31 |
$1K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
14 |
13 |
$1K |
| 0071A |
|
27 |
27 |
$1K |
| 99188 |
|
57 |
52 |
$940.00 |
| 0154A |
|
14 |
14 |
$560.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
28 |
24 |
$550.00 |
| 0072A |
|
13 |
13 |
$480.00 |
| 0073A |
|
12 |
12 |
$480.00 |
| D1206 |
Topical application of fluoride varnish |
28 |
24 |
$440.00 |
| 99050 |
|
12 |
12 |
$129.70 |
| 90686 |
|
816 |
779 |
$0.00 |
| 91307 |
|
79 |
73 |
$0.00 |
| 91315 |
|
14 |
14 |
$0.00 |
| 90672 |
|
145 |
145 |
$0.00 |
| 90670 |
|
12 |
12 |
$0.00 |
| 91311 |
|
21 |
16 |
$0.00 |
| 90685 |
|
20 |
16 |
$0.00 |