| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
664 |
551 |
$23K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
247 |
198 |
$13K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
150 |
86 |
$9K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
111 |
93 |
$6K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
294 |
162 |
$5K |
| 99460 |
|
90 |
83 |
$3K |
| 90686 |
|
296 |
252 |
$2K |
| 99238 |
Hospital discharge day management, 30 minutes or less |
57 |
56 |
$2K |
| 90670 |
|
182 |
126 |
$1K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
12 |
12 |
$966.81 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
12 |
12 |
$882.51 |
| 90648 |
|
113 |
69 |
$812.64 |
| 90680 |
|
72 |
61 |
$458.49 |
| D1206 |
Topical application of fluoride varnish |
14 |
14 |
$366.08 |
| 90723 |
|
14 |
14 |
$90.51 |