| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,919 |
2,129 |
$118K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
845 |
634 |
$53K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
635 |
551 |
$46K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
1,149 |
968 |
$19K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
177 |
159 |
$13K |
| D1206 |
Topical application of fluoride varnish |
222 |
209 |
$6K |
| 90670 |
|
552 |
466 |
$5K |
| 96127 |
|
269 |
240 |
$4K |
| 92551 |
|
286 |
255 |
$4K |
| 90686 |
|
570 |
453 |
$4K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
254 |
108 |
$4K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
30 |
27 |
$3K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
122 |
34 |
$2K |
| 90648 |
|
397 |
320 |
$2K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
608 |
386 |
$2K |
| 90680 |
|
298 |
216 |
$2K |
| 90723 |
|
220 |
194 |
$1K |
| 96160 |
|
104 |
102 |
$1K |
| 90633 |
|
133 |
98 |
$1K |
| 90461 |
|
386 |
233 |
$964.36 |
| 99173 |
|
91 |
82 |
$674.59 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
18 |
12 |
$461.70 |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
28 |
13 |
$362.50 |
| 90734 |
|
21 |
15 |
$357.50 |
| 90681 |
|
13 |
13 |
$83.20 |
| 96161 |
|
119 |
69 |
$0.00 |