| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
5,278 |
4,375 |
$309K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,460 |
2,184 |
$210K |
| 99199 |
Unlisted special service, procedure or report |
11,637 |
7,387 |
$75K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
701 |
664 |
$57K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
701 |
663 |
$55K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
494 |
464 |
$40K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
2,035 |
1,898 |
$34K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
1,167 |
1,078 |
$31K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
256 |
225 |
$18K |
| D0145 |
Oral evaluation for a patient under three years of age |
259 |
252 |
$8K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
970 |
862 |
$7K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
618 |
522 |
$7K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
795 |
382 |
$5K |
| D1206 |
Topical application of fluoride varnish |
259 |
252 |
$4K |
| 96127 |
|
184 |
166 |
$578.18 |
| 99441 |
|
18 |
13 |
$407.16 |
| 81003 |
|
1,540 |
1,407 |
$402.13 |
| 99421 |
|
13 |
13 |
$333.00 |
| 92551 |
|
1,349 |
1,240 |
$322.38 |
| 96161 |
|
301 |
284 |
$289.11 |
| 85013 |
|
1,660 |
1,524 |
$20.89 |
| 90686 |
|
344 |
304 |
$18.82 |
| 99173 |
|
1,224 |
1,132 |
$0.00 |
| 90670 |
|
497 |
471 |
$0.00 |
| 90715 |
|
12 |
12 |
$0.00 |
| 90649 |
|
20 |
17 |
$0.00 |
| 90633 |
|
37 |
33 |
$0.00 |
| 83655 |
|
46 |
44 |
$0.00 |
| 90685 |
|
13 |
13 |
$0.00 |
| 90710 |
|
12 |
12 |
$0.00 |
| 90698 |
|
524 |
497 |
$0.00 |
| 90744 |
|
39 |
39 |
$0.00 |
| 90680 |
|
140 |
128 |
$0.00 |
| 90733 |
|
29 |
29 |
$0.00 |
| 90716 |
|
14 |
13 |
$0.00 |