| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
779 |
681 |
$44K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
249 |
244 |
$20K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
149 |
149 |
$12K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
159 |
150 |
$12K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
127 |
127 |
$11K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
31 |
31 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
142 |
136 |
$2K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
156 |
155 |
$2K |
| D9999 |
Unspecified adjunctive procedure, by report |
97 |
96 |
$2K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
25 |
25 |
$868.64 |
| 85018 |
|
301 |
301 |
$800.68 |
| D1206 |
Topical application of fluoride varnish |
62 |
61 |
$768.50 |
| 90670 |
|
122 |
122 |
$740.24 |
| 36416 |
|
298 |
298 |
$738.81 |
| 81002 |
|
246 |
240 |
$708.45 |
| 90680 |
|
85 |
85 |
$513.96 |
| 90648 |
|
69 |
69 |
$415.72 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
30 |
30 |
$392.19 |
| 90633 |
|
30 |
30 |
$183.30 |
| 90686 |
|
26 |
25 |
$152.24 |
| 90723 |
|
24 |
24 |
$140.50 |
| 90710 |
|
12 |
12 |
$73.50 |
| 90698 |
|
12 |
12 |
$67.54 |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
157 |
152 |
$39.64 |
| 99173 |
|
205 |
205 |
$5.79 |