| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
1,425 |
1,389 |
$129K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
1,015 |
995 |
$87K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
2,036 |
1,987 |
$80K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
976 |
915 |
$60K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,495 |
1,447 |
$56K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
529 |
488 |
$46K |
| D0145 |
Oral evaluation for a patient under three years of age |
871 |
850 |
$31K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
293 |
293 |
$28K |
| 90461 |
|
1,516 |
1,481 |
$17K |
| 92552 |
|
590 |
586 |
$14K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
875 |
762 |
$7K |
| 99173 |
|
763 |
756 |
$1K |
| 83655 |
|
97 |
95 |
$817.86 |
| D1206 |
Topical application of fluoride varnish |
17 |
17 |
$460.94 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
36 |
16 |
$239.40 |
| 85018 |
|
15 |
13 |
$17.58 |
| 90670 |
|
1,010 |
988 |
$0.83 |
| 90647 |
|
651 |
637 |
$0.50 |
| 90686 |
|
190 |
188 |
$0.48 |
| 90688 |
|
25 |
25 |
$0.12 |
| 90716 |
|
177 |
171 |
$0.09 |
| 90707 |
|
177 |
171 |
$0.09 |
| 90633 |
|
272 |
269 |
$0.07 |
| 90680 |
|
674 |
661 |
$0.01 |
| 90723 |
|
711 |
699 |
$0.01 |
| 90685 |
|
15 |
15 |
$0.00 |