| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,234 |
1,094 |
$72K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
536 |
495 |
$47K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
264 |
241 |
$20K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
914 |
842 |
$17K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
467 |
432 |
$16K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
167 |
155 |
$14K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
65 |
59 |
$5K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
62 |
54 |
$5K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
408 |
390 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
36 |
36 |
$1K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
34 |
29 |
$962.69 |
| D1206 |
Topical application of fluoride varnish |
36 |
36 |
$567.36 |
| 90474 |
|
15 |
15 |
$306.75 |
| 90686 |
|
208 |
199 |
$305.79 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
15 |
14 |
$183.69 |
| 90633 |
|
47 |
44 |
$32.14 |
| 99173 |
|
267 |
222 |
$13.06 |
| 92551 |
|
272 |
222 |
$13.06 |
| 90670 |
|
114 |
113 |
$0.00 |
| 90685 |
|
44 |
42 |
$0.00 |
| 90647 |
|
45 |
44 |
$0.00 |
| 90723 |
|
17 |
17 |
$0.00 |
| 90680 |
|
28 |
27 |
$0.00 |
| 94760 |
|
18 |
17 |
$0.00 |