| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
1,634 |
914 |
$183K |
| 99199 |
Unlisted special service, procedure or report |
3,224 |
2,396 |
$21K |
| 36415 |
Collection of venous blood by venipuncture |
5,602 |
4,765 |
$16K |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
387 |
228 |
$15K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
574 |
371 |
$6K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
394 |
275 |
$6K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
293 |
257 |
$4K |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
74 |
67 |
$4K |
| 81025 |
|
395 |
331 |
$3K |
| 0002A |
|
48 |
30 |
$3K |
| 0001A |
|
55 |
33 |
$3K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
73 |
53 |
$2K |
| 81000 |
|
473 |
399 |
$2K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
12 |
12 |
$1K |
| 82962 |
|
292 |
278 |
$850.35 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
82 |
81 |
$708.75 |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
15 |
12 |
$602.52 |
| 59025 |
Fetal non-stress test |
43 |
14 |
$485.80 |
| 85610 |
|
94 |
65 |
$448.29 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
12 |
12 |
$174.84 |
| G0071 |
Payment for communication technology-based services for 5 minutes or more of a virtual (non-face-to-face) communication between an rural health clinic (rhc) or federally qualified health center (fqhc) practitioner and rhc or fqhc patient, or 5 minutes or more of remote evaluation of recorded video and/or images by an rhc or fqhc practitioner, occurring in lieu of an office visit; rhc or fqhc only |
23 |
12 |
$128.00 |
| 91300 |
|
131 |
79 |
$0.01 |
| 90649 |
|
14 |
13 |
$0.00 |
| 90756 |
|
50 |
50 |
$0.00 |
| 90674 |
|
129 |
129 |
$0.00 |
| 90686 |
|
178 |
157 |
$0.00 |