| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
35,204 |
27,005 |
$7.67M |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
5,559 |
4,660 |
$2K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
5,936 |
4,868 |
$730.95 |
| 0001A |
|
103 |
102 |
$400.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
2,975 |
2,506 |
$281.03 |
| 0002A |
|
96 |
96 |
$240.00 |
| 97110 |
Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion |
804 |
444 |
$190.48 |
| G0467 |
Federally qualified health center (fqhc) visit, established patient; a medically-necessary, face-to-face encounter (one-on-one) between an established patient and a fqhc practitioner during which time one or more fqhc services are rendered and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving a fqhc visit |
594 |
539 |
$102.61 |
| 90686 |
|
942 |
818 |
$88.24 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
1,364 |
1,147 |
$82.78 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
403 |
292 |
$78.23 |
| 90688 |
|
477 |
360 |
$67.80 |
| 97140 |
Manual therapy techniques, each 15 minutes (e.g., mobilization/manipulation, manual lymphatic drainage) |
555 |
322 |
$48.47 |
| 0012A |
|
13 |
13 |
$40.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
137 |
102 |
$34.30 |
| 90670 |
|
379 |
324 |
$32.47 |
| 1220F |
|
915 |
814 |
$0.01 |
| 1159F |
|
1,842 |
1,477 |
$0.01 |
| 1036F |
|
1,792 |
1,452 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
2,410 |
2,184 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
2,154 |
1,972 |
$0.00 |
| D1330 |
|
451 |
368 |
$0.00 |
| 90723 |
|
181 |
164 |
$0.00 |
| 92551 |
|
469 |
321 |
$0.00 |
| 1125F |
|
222 |
192 |
$0.00 |
| 96127 |
|
204 |
172 |
$0.00 |
| 1126F |
|
564 |
334 |
$0.00 |
| 90647 |
|
206 |
174 |
$0.00 |
| 91301 |
|
80 |
78 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
406 |
260 |
$0.00 |
| 96156 |
|
230 |
224 |
$0.00 |
| 0011A |
|
68 |
68 |
$0.00 |
| 90651 |
|
31 |
25 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
48 |
41 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
14 |
12 |
$0.00 |
| D1310 |
|
451 |
368 |
$0.00 |
| 90474 |
|
57 |
51 |
$0.00 |
| 97112 |
Therapeutic procedure, each 15 minutes; neuromuscular reeducation of movement, balance, coordination |
89 |
62 |
$0.00 |
| D0603 |
|
121 |
120 |
$0.00 |
| 90716 |
|
15 |
15 |
$0.00 |
| 97162 |
|
12 |
12 |
$0.00 |
| G0439 |
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit |
13 |
13 |
$0.00 |
| 99051 |
|
282 |
274 |
$0.00 |
| 1158F |
|
609 |
575 |
$0.00 |
| D0330 |
Panoramic radiographic image |
103 |
96 |
$0.00 |
| G0511 |
Rural health clinic or federally qualified health center (rhc or fqhc) only, general care management, 20 minutes or more of clinical staff time for chronic care management services or behavioral health integration services directed by an rhc or fqhc practitioner (physician, np, pa, or cnm), per calendar month |
94 |
94 |
$0.00 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
639 |
443 |
$0.00 |
| 90715 |
|
178 |
141 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
2,183 |
1,978 |
$0.00 |
| 81003 |
|
579 |
471 |
$0.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
155 |
127 |
$0.00 |
| 90633 |
|
17 |
12 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
554 |
459 |
$0.00 |
| D0190 |
|
2,936 |
2,707 |
$0.00 |
| 99173 |
|
201 |
139 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
314 |
227 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
549 |
432 |
$0.00 |
| 81002 |
|
15 |
13 |
$0.00 |
| D0270 |
|
61 |
57 |
$0.00 |
| 81025 |
|
101 |
96 |
$0.00 |
| 96152 |
|
104 |
85 |
$0.00 |
| 99177 |
|
118 |
88 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
96 |
61 |
$0.00 |
| 90734 |
|
16 |
12 |
$0.00 |
| G0468 |
Federally qualified health center (fqhc) visit, ippe or awv; a fqhc visit that includes an initial preventive physical examination (ippe) or annual wellness visit (awv) and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving an ippe or awv |
14 |
14 |
$0.00 |
| 90681 |
|
37 |
37 |
$0.00 |
| 91300 |
|
196 |
177 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
14 |
14 |
$0.00 |
| 1160F |
|
21 |
20 |
$0.00 |
| D1120 |
Prophylaxis - child |
17 |
12 |
$0.00 |
| 90707 |
|
15 |
15 |
$0.00 |
| 90750 |
|
15 |
14 |
$0.00 |