| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
5,193 |
4,197 |
$1.23M |
| D0999 |
Unspecified diagnostic procedure, by report |
4,108 |
2,513 |
$821K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,943 |
2,409 |
$72K |
| 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 |
1,815 |
1,595 |
$53K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
290 |
285 |
$17K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
210 |
206 |
$12K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
185 |
179 |
$11K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
796 |
750 |
$7K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
62 |
62 |
$3K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
406 |
393 |
$2K |
| 99000 |
|
602 |
511 |
$2K |
| 90674 |
|
327 |
314 |
$594.73 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,748 |
1,670 |
$286.05 |
| 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 |
40 |
40 |
$254.54 |
| 90670 |
|
369 |
357 |
$230.00 |
| 87428 |
|
29 |
26 |
$185.64 |
| 0001A |
|
19 |
19 |
$169.40 |
| 0072A |
|
31 |
30 |
$150.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
1,064 |
1,020 |
$130.08 |
| 90715 |
|
13 |
13 |
$120.99 |
| 0002A |
|
13 |
13 |
$113.56 |
| 0071A |
|
14 |
14 |
$80.00 |
| D1206 |
Topical application of fluoride varnish |
1,383 |
1,339 |
$29.40 |
| 92551 |
|
116 |
114 |
$19.08 |
| 36415 |
Collection of venous blood by venipuncture |
455 |
444 |
$0.00 |
| D0603 |
|
887 |
869 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
884 |
857 |
$0.00 |
| D1310 |
|
230 |
224 |
$0.00 |
| D1330 |
|
250 |
241 |
$0.00 |
| 90680 |
|
91 |
88 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
64 |
60 |
$0.00 |
| D0602 |
|
173 |
165 |
$0.00 |
| 90744 |
|
15 |
15 |
$0.00 |
| G0009 |
Administration of pneumococcal vaccine |
12 |
12 |
$0.00 |
| 90698 |
|
90 |
87 |
$0.00 |
| Q2039 |
Influenza virus vaccine, not otherwise specified |
14 |
14 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
50 |
50 |
$0.00 |
| G0439 |
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit |
39 |
39 |
$0.00 |
| 90686 |
|
12 |
12 |
$0.00 |
| 90660 |
|
14 |
13 |
$0.00 |
| 90716 |
|
12 |
12 |
$0.00 |
| D1110 |
Prophylaxis - adult |
49 |
47 |
$0.00 |
| D0330 |
Panoramic radiographic image |
15 |
14 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
24 |
24 |
$0.00 |
| 90661 |
|
34 |
33 |
$0.00 |
| 90633 |
|
16 |
16 |
$0.00 |
| D1120 |
Prophylaxis - child |
678 |
658 |
$0.00 |
| 90648 |
|
32 |
32 |
$0.00 |
| 81002 |
|
28 |
26 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
242 |
229 |
$0.00 |
| 91300 |
|
44 |
44 |
$0.00 |
| 99173 |
|
74 |
73 |
$0.00 |
| 90710 |
|
13 |
13 |
$0.00 |