| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
2,139 |
1,666 |
$162K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
2,158 |
1,675 |
$146K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,787 |
1,460 |
$81K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
2,653 |
2,199 |
$47K |
| 90670 |
|
1,804 |
1,349 |
$35K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
442 |
412 |
$32K |
| 96127 |
|
934 |
842 |
$13K |
| 83655 |
|
980 |
776 |
$11K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
163 |
152 |
$11K |
| 90698 |
|
993 |
693 |
$8K |
| 99381 |
|
69 |
64 |
$6K |
| 90633 |
|
795 |
613 |
$5K |
| 90686 |
|
695 |
582 |
$5K |
| 90647 |
|
743 |
497 |
$5K |
| 90723 |
|
655 |
443 |
$4K |
| 90681 |
|
302 |
252 |
$4K |
| 90680 |
|
616 |
413 |
$4K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
48 |
46 |
$3K |
| 90744 |
|
382 |
324 |
$3K |
| 85018 |
|
984 |
786 |
$2K |
| 90716 |
|
144 |
117 |
$2K |
| 90707 |
|
151 |
117 |
$2K |
| D1206 |
Topical application of fluoride varnish |
21 |
16 |
$539.70 |
| 90700 |
|
43 |
42 |
$275.20 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
20 |
17 |
$256.61 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
13 |
13 |
$74.02 |
| 36415 |
Collection of venous blood by venipuncture |
14 |
14 |
$48.76 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
45 |
43 |
$0.00 |
| 90461 |
|
17 |
15 |
$0.00 |