| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,982 |
2,399 |
$170K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,376 |
1,151 |
$111K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
2,413 |
1,766 |
$76K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
625 |
503 |
$46K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
344 |
283 |
$24K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
2,000 |
1,532 |
$22K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
132 |
113 |
$10K |
| D1206 |
Topical application of fluoride varnish |
318 |
270 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
138 |
97 |
$3K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
21 |
12 |
$2K |
| 90686 |
|
487 |
430 |
$2K |
| 92551 |
|
152 |
142 |
$2K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
15 |
13 |
$1K |
| 90670 |
|
111 |
108 |
$1K |
| 99173 |
|
274 |
223 |
$913.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
16 |
13 |
$815.93 |
| 0071A |
|
32 |
15 |
$733.97 |
| 0072A |
|
21 |
12 |
$625.31 |
| 90673 |
|
55 |
46 |
$548.48 |
| 96127 |
|
80 |
64 |
$416.65 |
| G8431 |
Screening for depression is documented as being positive and a follow-up plan is documented |
18 |
12 |
$372.42 |
| 90461 |
|
327 |
197 |
$364.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
17 |
16 |
$294.84 |
| 90648 |
|
264 |
205 |
$271.17 |
| 90671 |
|
90 |
60 |
$216.09 |
| 90656 |
|
31 |
29 |
$141.18 |
| 90723 |
|
58 |
50 |
$107.30 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
18 |
13 |
$59.34 |
| 36415 |
Collection of venous blood by venipuncture |
15 |
13 |
$41.08 |
| 90680 |
|
46 |
38 |
$0.00 |
| 90651 |
|
13 |
12 |
$0.00 |