| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
7,880 |
5,980 |
$1.43M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
18,194 |
16,620 |
$197K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
10,924 |
9,675 |
$161K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
4,755 |
3,810 |
$98K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
1,309 |
1,287 |
$44K |
| 90461 |
|
2,057 |
1,426 |
$26K |
| D0120 |
Periodic oral evaluation - established patient |
253 |
213 |
$25K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
613 |
598 |
$18K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
444 |
438 |
$14K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
248 |
242 |
$13K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
774 |
745 |
$8K |
| 90677 |
|
36 |
36 |
$7K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
198 |
198 |
$6K |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
523 |
419 |
$6K |
| 0064A |
|
149 |
146 |
$5K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
342 |
342 |
$4K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
64 |
64 |
$2K |
| 99385 |
|
39 |
37 |
$1K |
| 90686 |
|
557 |
515 |
$1K |
| 90658 |
|
266 |
261 |
$835.82 |
| 0004A |
|
17 |
17 |
$644.21 |
| 90656 |
|
219 |
219 |
$553.57 |
| 99386 |
|
12 |
12 |
$522.98 |
| 90715 |
|
24 |
24 |
$505.19 |
| 90685 |
|
33 |
33 |
$455.54 |
| 36415 |
Collection of venous blood by venipuncture |
390 |
389 |
$430.50 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
12 |
12 |
$372.21 |
| 90632 |
|
12 |
12 |
$360.00 |
| 0011A |
|
15 |
15 |
$358.58 |
| 90670 |
|
206 |
189 |
$226.43 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
14 |
14 |
$219.60 |
| 90633 |
|
146 |
137 |
$199.86 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
14 |
12 |
$118.00 |
| 90688 |
|
48 |
46 |
$110.21 |
| 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 |
423 |
353 |
$69.20 |
| 92551 |
|
13 |
13 |
$15.05 |
| 99173 |
|
26 |
26 |
$5.00 |
| 90832 |
Psychotherapy, 30 minutes with patient |
5,009 |
3,747 |
$0.00 |
| D0330 |
Panoramic radiographic image |
73 |
73 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
148 |
140 |
$0.00 |
| D1999 |
|
14 |
12 |
$0.00 |
| 90853 |
Group psychotherapy (other than of a multiple-family group) |
24 |
24 |
$0.00 |
| 99215 |
Prolong outpt/office vis |
12 |
12 |
$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 |
32 |
16 |
$0.00 |
| 90837 |
Psychotherapy, 53 minutes with patient |
17 |
16 |
$0.00 |
| 90700 |
|
12 |
12 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
73 |
43 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
56 |
54 |
$0.00 |
| 90834 |
Psychotherapy, 45 minutes with patient |
154 |
146 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
14 |
14 |
$0.00 |