| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
59,125 |
40,515 |
$5.10M |
| 99199 |
Unlisted special service, procedure or report |
164,187 |
118,196 |
$872K |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
1,060 |
789 |
$47K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
4,602 |
3,055 |
$37K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
829 |
439 |
$37K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
607 |
427 |
$35K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
1,709 |
1,108 |
$32K |
| S0280 |
Medical home program, comprehensive care coordination and planning, initial plan |
959 |
669 |
$31K |
| 81003 |
|
16,440 |
9,345 |
$29K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
564 |
295 |
$28K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
444 |
314 |
$27K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
432 |
312 |
$25K |
| 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 |
1,215 |
1,078 |
$21K |
| 81025 |
|
4,557 |
2,302 |
$16K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
2,641 |
1,548 |
$16K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
223 |
132 |
$13K |
| D1351 |
Sealant - per tooth |
337 |
75 |
$10K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
476 |
264 |
$8K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
202 |
133 |
$8K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
1,018 |
300 |
$8K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
1,235 |
875 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
159 |
148 |
$7K |
| D1120 |
Prophylaxis - child |
233 |
225 |
$6K |
| 0012A |
|
133 |
124 |
$6K |
| 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 |
535 |
434 |
$5K |
| 0011A |
|
157 |
126 |
$5K |
| 0001A |
|
161 |
65 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
146 |
129 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
235 |
227 |
$4K |
| 0002A |
|
135 |
70 |
$4K |
| D0272 |
Bitewings - two radiographic images |
204 |
196 |
$4K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
414 |
218 |
$3K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
412 |
325 |
$3K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
199 |
168 |
$3K |
| 80061 |
Lipid panel |
351 |
295 |
$3K |
| 90686 |
|
1,144 |
940 |
$3K |
| 76801 |
|
35 |
24 |
$2K |
| G2023 |
Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
185 |
115 |
$2K |
| 87210 |
|
1,336 |
344 |
$2K |
| U0003 |
Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high throughput technologies as described by cms-2020-01-r |
40 |
29 |
$2K |
| 85018 |
|
4,732 |
2,089 |
$2K |
| D1206 |
Topical application of fluoride varnish |
113 |
100 |
$2K |
| 76830 |
Ultrasound, transvaginal |
32 |
25 |
$2K |
| 0071A |
|
57 |
29 |
$1K |
| 87428 |
|
25 |
19 |
$1K |
| 82948 |
|
1,688 |
837 |
$1K |
| 80305 |
|
88 |
44 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
40 |
40 |
$970.56 |
| 0013A |
|
22 |
16 |
$653.14 |
| 99454 |
|
12 |
12 |
$471.33 |
| 0064A |
|
52 |
16 |
$421.00 |
| 98968 |
|
14 |
12 |
$409.80 |
| 96127 |
|
110 |
84 |
$402.21 |
| 92551 |
|
1,085 |
900 |
$389.42 |
| 90715 |
|
12 |
12 |
$347.37 |
| 80053 |
Comprehensive metabolic panel |
143 |
87 |
$340.80 |
| 90688 |
|
41 |
31 |
$147.15 |
| 99173 |
|
993 |
855 |
$104.70 |
| 92587 |
|
15 |
14 |
$60.16 |
| 99072 |
|
140 |
82 |
$48.15 |
| 1159F |
|
1,985 |
1,903 |
$0.00 |
| 3078F |
|
884 |
846 |
$0.00 |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
1,566 |
1,112 |
$0.00 |
| 90633 |
|
82 |
72 |
$0.00 |
| 0502F |
|
44 |
38 |
$0.00 |
| 90670 |
|
376 |
324 |
$0.00 |
| 90707 |
|
83 |
80 |
$0.00 |
| 90681 |
|
31 |
24 |
$0.00 |
| 90685 |
|
33 |
29 |
$0.00 |
| 91300 |
|
99 |
44 |
$0.00 |
| 90647 |
|
247 |
197 |
$0.00 |
| 1126F |
|
426 |
416 |
$0.00 |
| 3074F |
|
1,212 |
1,160 |
$0.00 |
| 3079F |
|
163 |
159 |
$0.00 |
| 90723 |
|
244 |
188 |
$0.00 |
| 90716 |
|
57 |
55 |
$0.00 |
| 90651 |
|
75 |
69 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
217 |
183 |
$0.00 |
| 3075F |
|
12 |
12 |
$0.00 |
| 91307 |
|
95 |
45 |
$0.00 |
| 91301 |
|
48 |
28 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
14 |
12 |
$0.00 |
| Q3014 |
Telehealth originating site facility fee |
63 |
31 |
$0.00 |
| 3044F |
|
66 |
65 |
$0.00 |
| 90696 |
|
13 |
13 |
$0.00 |