| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,777 |
2,423 |
$226K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
1,720 |
1,503 |
$66K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
927 |
838 |
$65K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
881 |
746 |
$65K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
706 |
615 |
$52K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
879 |
816 |
$49K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
426 |
352 |
$31K |
| D0145 |
Oral evaluation for a patient under three years of age |
659 |
580 |
$17K |
| 99408 |
|
493 |
392 |
$12K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
1,107 |
1,004 |
$8K |
| D1206 |
Topical application of fluoride varnish |
656 |
579 |
$7K |
| 99215 |
Prolong outpt/office vis |
66 |
64 |
$6K |
| 99406 |
|
495 |
393 |
$4K |
| 96127 |
|
1,045 |
879 |
$4K |
| 90686 |
|
129 |
121 |
$82.75 |
| 99172 |
|
1,209 |
1,063 |
$14.00 |
| 90710 |
|
241 |
203 |
$0.00 |
| 90670 |
|
686 |
621 |
$0.00 |
| 90633 |
|
288 |
259 |
$0.00 |
| 81002 |
|
42 |
42 |
$0.00 |
| 90715 |
|
35 |
29 |
$0.00 |
| 90734 |
|
45 |
39 |
$0.00 |
| 90645 |
|
533 |
464 |
$0.00 |
| 85018 |
|
367 |
310 |
$0.00 |
| 90723 |
|
382 |
345 |
$0.00 |
| 90680 |
|
465 |
429 |
$0.00 |
| 90716 |
|
14 |
14 |
$0.00 |
| 92587 |
|
124 |
105 |
$0.00 |
| 90696 |
|
95 |
78 |
$0.00 |
| 90698 |
|
15 |
15 |
$0.00 |