| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
3,193 |
2,808 |
$37K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
1,868 |
1,779 |
$29K |
| D1206 |
Topical application of fluoride varnish |
611 |
581 |
$16K |
| 96127 |
|
1,024 |
979 |
$15K |
| 0012A |
|
335 |
335 |
$13K |
| 90734 |
|
681 |
593 |
$12K |
| 92551 |
|
779 |
724 |
$12K |
| 0011A |
|
351 |
350 |
$11K |
| 90651 |
|
299 |
254 |
$10K |
| 90686 |
|
744 |
696 |
$6K |
| 99173 |
|
731 |
675 |
$5K |
| H1000 |
Prenatal care, at-risk assessment |
358 |
338 |
$5K |
| 0001A |
|
114 |
110 |
$5K |
| 0002A |
|
114 |
110 |
$5K |
| 90715 |
|
275 |
242 |
$4K |
| 99402 |
|
115 |
107 |
$3K |
| 90677 |
|
57 |
47 |
$3K |
| 91320 |
|
16 |
12 |
$2K |
| 0071A |
|
36 |
36 |
$2K |
| 0072A |
|
32 |
32 |
$1K |
| 0064A |
|
30 |
30 |
$1K |
| 90723 |
|
101 |
84 |
$1K |
| 90670 |
|
100 |
87 |
$1K |
| 90648 |
|
134 |
110 |
$1K |
| 0124A |
|
30 |
27 |
$1K |
| D1120 |
Prophylaxis - child |
26 |
26 |
$1K |
| 90633 |
|
108 |
105 |
$1K |
| 0004A |
|
20 |
20 |
$842.80 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
19 |
19 |
$610.85 |
| 0031A |
|
14 |
14 |
$589.96 |
| 90620 |
|
23 |
13 |
$497.16 |
| 36416 |
|
127 |
116 |
$484.21 |
| 90680 |
|
41 |
31 |
$478.91 |
| 90710 |
|
43 |
42 |
$419.54 |
| 90656 |
|
20 |
17 |
$417.93 |
| D0120 |
Periodic oral evaluation - established patient |
13 |
12 |
$364.00 |
| 86580 |
|
75 |
43 |
$318.30 |
| D1208 |
Topical application of fluoride, excluding varnish |
12 |
12 |
$300.85 |
| 90696 |
|
26 |
26 |
$300.43 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
15 |
15 |
$219.00 |
| 90672 |
|
13 |
13 |
$83.20 |
| 90716 |
|
12 |
12 |
$76.80 |
| 85018 |
|
16 |
16 |
$37.12 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
96 |
91 |
$16.21 |