| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
3,977 |
3,662 |
$232K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
5,060 |
4,665 |
$190K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
5,346 |
2,897 |
$101K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
947 |
895 |
$48K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
510 |
470 |
$23K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
3,280 |
2,715 |
$21K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
337 |
324 |
$17K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
1,151 |
1,070 |
$13K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
983 |
474 |
$11K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
413 |
402 |
$6K |
| 92583 |
|
279 |
264 |
$6K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
210 |
193 |
$4K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
70 |
69 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
60 |
58 |
$774.00 |
| 96127 |
|
216 |
213 |
$731.02 |
| 99381 |
|
12 |
12 |
$717.75 |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
19 |
16 |
$299.45 |
| 99173 |
|
153 |
147 |
$295.14 |
| 85018 |
|
94 |
92 |
$225.82 |
| 90686 |
|
375 |
360 |
$185.04 |
| 36416 |
|
60 |
60 |
$116.49 |
| 90648 |
|
284 |
270 |
$45.00 |
| 90670 |
|
325 |
308 |
$30.00 |
| 90680 |
|
132 |
128 |
$20.00 |
| 90723 |
|
179 |
174 |
$20.00 |
| 90633 |
|
164 |
158 |
$15.00 |
| 90461 |
|
417 |
403 |
$10.50 |
| 94760 |
|
1,066 |
970 |
$2.03 |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
13 |
12 |
$0.13 |
| 90734 |
|
13 |
13 |
$0.00 |
| 90685 |
|
37 |
36 |
$0.00 |
| 90716 |
|
14 |
14 |
$0.00 |
| 90647 |
|
14 |
13 |
$0.00 |
| 99000 |
|
383 |
370 |
$0.00 |