| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
3,363 |
3,005 |
$317K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
3,476 |
3,243 |
$242K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
503 |
500 |
$45K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
277 |
275 |
$25K |
| 99429 |
|
955 |
945 |
$22K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
203 |
196 |
$17K |
| 90686 |
|
1,222 |
1,188 |
$17K |
| 99499 |
|
564 |
563 |
$14K |
| 99188 |
|
1,298 |
1,110 |
$13K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
1,627 |
1,460 |
$9K |
| 36416 |
|
2,329 |
2,299 |
$7K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
44 |
43 |
$6K |
| 85018 |
|
2,294 |
2,270 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
213 |
178 |
$4K |
| D1206 |
Topical application of fluoride varnish |
451 |
336 |
$4K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
37 |
36 |
$3K |
| D9999 |
Unspecified adjunctive procedure, by report |
152 |
122 |
$3K |
| 0071A |
|
70 |
69 |
$3K |
| 0072A |
|
67 |
67 |
$3K |
| 99383 |
|
26 |
26 |
$2K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
24 |
24 |
$2K |
| 99382 |
|
18 |
15 |
$2K |
| 90670 |
|
117 |
115 |
$1K |
| 99173 |
|
714 |
707 |
$1K |
| 0001A |
|
27 |
27 |
$1K |
| 0002A |
|
26 |
26 |
$1K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
28 |
28 |
$972.44 |
| 0082A |
|
19 |
19 |
$760.00 |
| 0081A |
|
13 |
13 |
$520.00 |
| 0083A |
|
13 |
13 |
$520.00 |
| 0011A |
|
12 |
12 |
$480.00 |
| 96127 |
|
166 |
129 |
$361.46 |
| 90672 |
|
13 |
13 |
$255.97 |
| 90648 |
|
25 |
25 |
$238.50 |
| 90685 |
|
14 |
14 |
$227.78 |
| 99174 |
|
68 |
68 |
$205.32 |
| 90688 |
|
20 |
20 |
$190.80 |
| 87430 |
|
12 |
12 |
$163.08 |
| 91318 |
|
15 |
15 |
$83.44 |
| 94760 |
|
168 |
156 |
$6.44 |
| 91301 |
|
38 |
37 |
$0.00 |
| S8301 |
Infection control supplies, not otherwise specified |
87 |
78 |
$0.00 |
| 91307 |
|
160 |
152 |
$0.00 |
| 99000 |
|
189 |
180 |
$0.00 |
| 91300 |
|
102 |
94 |
$0.00 |
| 99072 |
|
1,195 |
1,127 |
$0.00 |
| 91308 |
|
54 |
49 |
$0.00 |