| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
359 |
326 |
$27K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
111 |
94 |
$11K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
110 |
105 |
$10K |
| D0145 |
Oral evaluation for a patient under three years of age |
226 |
215 |
$8K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
89 |
87 |
$8K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
187 |
179 |
$6K |
| 92552 |
|
239 |
230 |
$6K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
27 |
26 |
$2K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
252 |
226 |
$2K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
31 |
31 |
$1K |
| 99173 |
|
236 |
228 |
$379.02 |
| D1206 |
Topical application of fluoride varnish |
14 |
14 |
$350.70 |
| S9470 |
Nutritional counseling, dietitian visit |
180 |
171 |
$101.00 |
| 85018 |
|
34 |
30 |
$86.40 |
| 96161 |
|
16 |
15 |
$3.65 |
| 90648 |
|
52 |
51 |
$0.00 |
| 90670 |
|
95 |
90 |
$0.00 |
| 90633 |
|
13 |
12 |
$0.00 |
| 90680 |
|
61 |
59 |
$0.00 |
| 90723 |
|
38 |
38 |
$0.00 |
| 90698 |
|
13 |
12 |
$0.00 |