| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
37,413 |
25,702 |
$8.17M |
| T1016 |
Case management, each 15 minutes |
1,868 |
1,020 |
$114K |
| H0004 |
Behavioral health counseling and therapy, per 15 minutes |
1,982 |
950 |
$8K |
| S0215 |
Non-emergency transportation; mileage, per mile |
181 |
61 |
$4K |
| A0120 |
Non-emergency transportation: mini-bus, mountain area transports, or other transportation systems |
181 |
61 |
$2K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,576 |
1,381 |
$128.36 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
320 |
298 |
$84.10 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
108 |
106 |
$78.72 |
| H2014 |
Skills training and development, per 15 minutes |
841 |
393 |
$52.99 |
| U0002 |
2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc |
36 |
35 |
$51.31 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
4,195 |
3,320 |
$31.55 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
375 |
329 |
$21.82 |
| 99441 |
|
961 |
874 |
$10.83 |
| D0240 |
|
635 |
566 |
$0.00 |
| 3008F |
|
4,854 |
3,807 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
3,406 |
2,868 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
891 |
794 |
$0.00 |
| 90686 |
|
33 |
33 |
$0.00 |
| 90680 |
|
90 |
88 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
293 |
291 |
$0.00 |
| 3080F |
|
109 |
101 |
$0.00 |
| 90698 |
|
44 |
44 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
2,178 |
1,947 |
$0.00 |
| 3079F |
|
740 |
669 |
$0.00 |
| 92507 |
Treatment of speech, language, voice, communication, and/or auditory processing disorder |
278 |
133 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
451 |
447 |
$0.00 |
| 99443 |
|
37 |
36 |
$0.00 |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
183 |
181 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
191 |
166 |
$0.00 |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
174 |
155 |
$0.00 |
| 3074F |
|
2,649 |
2,047 |
$0.00 |
| 92523 |
|
30 |
30 |
$0.00 |
| D1351 |
Sealant - per tooth |
168 |
58 |
$0.00 |
| 0500F |
|
13 |
12 |
$0.00 |
| 3075F |
|
321 |
302 |
$0.00 |
| 90656 |
|
235 |
234 |
$0.00 |
| 0134A |
|
32 |
32 |
$0.00 |
| 1125F |
|
201 |
190 |
$0.00 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
174 |
151 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
15 |
14 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
13 |
13 |
$0.00 |
| 1111F |
|
30 |
29 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
58 |
53 |
$0.00 |
| 99381 |
|
62 |
61 |
$0.00 |
| 1126F |
|
106 |
100 |
$0.00 |
| 90723 |
|
14 |
14 |
$0.00 |
| 1220F |
|
17 |
15 |
$0.00 |
| 3044F |
|
15 |
15 |
$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 |
2,920 |
2,838 |
$0.00 |
| 0502F |
|
780 |
444 |
$0.00 |
| D1120 |
Prophylaxis - child |
3,065 |
2,746 |
$0.00 |
| 99173 |
|
289 |
285 |
$0.00 |
| 90715 |
|
15 |
15 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
908 |
894 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
167 |
167 |
$0.00 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
1,477 |
1,304 |
$0.00 |
| 1160F |
|
913 |
802 |
$0.00 |
| D0191 |
|
1,107 |
940 |
$0.00 |
| 99442 |
|
253 |
238 |
$0.00 |
| 90670 |
|
113 |
110 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
56 |
43 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
206 |
193 |
$0.00 |
| 90837 |
Psychotherapy, 53 minutes with patient |
216 |
112 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
25 |
25 |
$0.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
191 |
188 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
174 |
171 |
$0.00 |
| 3078F |
|
2,453 |
1,947 |
$0.00 |
| G2023 |
Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
192 |
169 |
$0.00 |
| H0031 |
Mental health assessment, by non-physician |
400 |
289 |
$0.00 |
| 91313 |
|
32 |
32 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
64 |
63 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
239 |
238 |
$0.00 |
| Q2038 |
Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (fluzone) |
13 |
13 |
$0.00 |
| D0190 |
|
454 |
168 |
$0.00 |
| 3077F |
|
26 |
24 |
$0.00 |
| D1110 |
Prophylaxis - adult |
13 |
12 |
$0.00 |
| 90648 |
|
28 |
28 |
$0.00 |
| 99201 |
|
77 |
71 |
$0.00 |
| 90633 |
|
17 |
17 |
$0.00 |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
15 |
14 |
$0.00 |
| 90791 |
Psychiatric diagnostic evaluation |
13 |
13 |
$0.00 |
| T1013 |
Sign language or oral interpretive services, per 15 minutes |
15 |
15 |
$0.00 |