| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
76,401 |
40,636 |
$12.51M |
| 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 |
11,898 |
9,037 |
$418K |
| G0470 |
Federally qualified health center (fqhc) visit, mental health, established patient; a medically-necessary, face-to-face mental health 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 mental health visit |
6,252 |
2,768 |
$238K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
27,053 |
18,737 |
$132K |
| 90834 |
Psychotherapy, 45 minutes with patient |
19,572 |
9,653 |
$128K |
| D0120 |
Periodic oral evaluation - established patient |
1,839 |
1,632 |
$47K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
14,137 |
11,300 |
$42K |
| 90832 |
Psychotherapy, 30 minutes with patient |
5,762 |
3,587 |
$23K |
| 90837 |
Psychotherapy, 53 minutes with patient |
1,708 |
957 |
$15K |
| D1110 |
Prophylaxis - adult |
2,765 |
2,457 |
$15K |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
1,797 |
1,265 |
$15K |
| 90853 |
Group psychotherapy (other than of a multiple-family group) |
7,739 |
3,411 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
901 |
825 |
$12K |
| D0274 |
Bitewings - four radiographic images |
1,065 |
932 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
845 |
750 |
$9K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
2,381 |
1,742 |
$8K |
| D1120 |
Prophylaxis - child |
2,492 |
2,319 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
483 |
401 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
1,554 |
1,273 |
$4K |
| 80305 |
|
116 |
104 |
$2K |
| D0272 |
Bitewings - two radiographic images |
291 |
276 |
$2K |
| 99215 |
Prolong outpt/office vis |
449 |
424 |
$2K |
| D1206 |
Topical application of fluoride varnish |
2,766 |
2,565 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
709 |
521 |
$847.07 |
| 80053 |
Comprehensive metabolic panel |
112 |
107 |
$808.48 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
101 |
96 |
$633.73 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
19 |
16 |
$599.52 |
| 80061 |
Lipid panel |
57 |
57 |
$516.32 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
42 |
41 |
$485.82 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
248 |
190 |
$313.85 |
| Q3014 |
Telehealth originating site facility fee |
63 |
56 |
$302.63 |
| D0170 |
|
90 |
86 |
$299.76 |
| G0008 |
Administration of influenza virus vaccine |
16 |
15 |
$299.76 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
253 |
210 |
$299.76 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
117 |
103 |
$181.06 |
| 84443 |
Thyroid stimulating hormone (TSH) |
13 |
13 |
$177.42 |
| D0330 |
Panoramic radiographic image |
266 |
222 |
$90.34 |
| 36415 |
Collection of venous blood by venipuncture |
1,424 |
1,209 |
$67.93 |
| 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 |
377 |
377 |
$49.34 |
| 99000 |
|
584 |
570 |
$0.00 |
| D0603 |
|
321 |
307 |
$0.00 |
| 90694 |
|
15 |
14 |
$0.00 |
| 99496 |
|
15 |
13 |
$0.00 |
| G0439 |
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit |
329 |
329 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
159 |
118 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
149 |
127 |
$0.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
132 |
106 |
$0.00 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
137 |
86 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
76 |
62 |
$0.00 |
| 90686 |
|
72 |
68 |
$0.00 |
| 85027 |
|
13 |
13 |
$0.00 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
54 |
13 |
$0.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
110 |
107 |
$0.00 |
| 87811 |
Infectious agent antigen detection by immunoassay; SARS-CoV-2 (COVID-19) |
68 |
46 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
48 |
37 |
$0.00 |
| 3725F |
|
16 |
12 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
28 |
27 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
28 |
24 |
$0.00 |
| 99409 |
|
27 |
24 |
$0.00 |