| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
3,434 |
2,705 |
$151K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
877 |
652 |
$42K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
1,064 |
420 |
$18K |
| 92552 |
|
253 |
179 |
$5K |
| 99490 |
Ccm add 20min |
338 |
279 |
$5K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
528 |
199 |
$5K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
172 |
115 |
$3K |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
57 |
25 |
$3K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
167 |
154 |
$2K |
| 96127 |
|
536 |
293 |
$2K |
| 90688 |
|
336 |
291 |
$2K |
| 96160 |
|
291 |
169 |
$1K |
| 36415 |
Collection of venous blood by venipuncture |
732 |
550 |
$1K |
| 3074F |
|
1,305 |
984 |
$1K |
| 3078F |
|
1,000 |
747 |
$990.11 |
| 99173 |
|
216 |
150 |
$989.43 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
62 |
54 |
$660.93 |
| D1206 |
Topical application of fluoride varnish |
71 |
69 |
$541.50 |
| D0190 |
|
28 |
28 |
$324.00 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
56 |
44 |
$257.85 |
| 3079F |
|
262 |
185 |
$240.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
95 |
59 |
$203.04 |
| 36416 |
|
36 |
29 |
$48.44 |
| 81003 |
|
30 |
24 |
$33.26 |
| 90461 |
|
18 |
12 |
$26.20 |
| G0008 |
Administration of influenza virus vaccine |
16 |
14 |
$22.95 |
| G8420 |
Bmi is documented within normal parameters and no follow-up plan is required |
56 |
51 |
$0.00 |
| G8754 |
Most recent diastolic blood pressure < 90 mmhg |
19 |
13 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
41 |
41 |
$0.00 |
| G8417 |
Bmi is documented above normal parameters and a follow-up plan is documented |
671 |
448 |
$0.00 |
| 3725F |
|
279 |
180 |
$0.00 |
| G8482 |
Influenza immunization administered or previously received |
16 |
14 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
18 |
18 |
$0.00 |
| 90687 |
|
14 |
12 |
$0.00 |
| D1120 |
Prophylaxis - child |
37 |
37 |
$0.00 |
| D0330 |
Panoramic radiographic image |
22 |
22 |
$0.00 |