| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
1,607 |
1,423 |
$110K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
1,442 |
1,183 |
$109K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,262 |
1,152 |
$63K |
| 90677 |
|
279 |
242 |
$19K |
| 90698 |
|
1,217 |
986 |
$15K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
194 |
184 |
$15K |
| 90670 |
|
825 |
735 |
$12K |
| 90680 |
|
635 |
554 |
$8K |
| 90686 |
|
571 |
507 |
$7K |
| 90744 |
|
310 |
266 |
$4K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
201 |
160 |
$3K |
| 90633 |
|
213 |
158 |
$3K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
98 |
93 |
$2K |
| D1206 |
Topical application of fluoride varnish |
27 |
12 |
$718.90 |
| 83655 |
|
52 |
25 |
$616.72 |
| 90656 |
|
19 |
18 |
$317.49 |
| 90661 |
|
17 |
17 |
$284.07 |
| 90710 |
|
23 |
14 |
$134.40 |
| 85018 |
|
45 |
24 |
$104.40 |
| 99177 |
|
22 |
19 |
$0.00 |