| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
100 |
100 |
$3K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
67 |
67 |
$3K |
| 92551 |
|
132 |
132 |
$1K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
37 |
37 |
$1K |
| 90670 |
|
85 |
85 |
$540.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
12 |
12 |
$488.52 |
| 85018 |
|
182 |
182 |
$356.70 |
| 90707 |
|
37 |
37 |
$288.00 |
| 90698 |
|
39 |
39 |
$243.00 |
| 90716 |
|
24 |
24 |
$198.00 |
| 90658 |
|
14 |
14 |
$126.00 |
| 90633 |
|
13 |
13 |
$90.00 |
| 92081 |
|
94 |
94 |
$0.00 |
| 99401 |
|
28 |
28 |
$0.00 |
| 97802 |
|
27 |
27 |
$0.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
28 |
28 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
28 |
28 |
$0.00 |