| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
29,057 |
20,705 |
$3.55M |
| 99199 |
Unlisted special service, procedure or report |
150,829 |
61,265 |
$803K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,035 |
1,642 |
$65K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,093 |
1,557 |
$51K |
| 80305 |
|
831 |
585 |
$8K |
| 87636 |
Infectious agent detection by nucleic acid; SARS-CoV-2 and influenza virus types A and B |
13 |
12 |
$2K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
18 |
12 |
$1K |
| 99401 |
|
110 |
102 |
$1K |
| 92551 |
|
181 |
130 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
35 |
18 |
$839.70 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
110 |
88 |
$744.46 |
| D1110 |
Prophylaxis - adult |
35 |
18 |
$716.94 |
| D0274 |
Bitewings - four radiographic images |
31 |
16 |
$503.25 |
| 90834 |
Psychotherapy, 45 minutes with patient |
135 |
80 |
$501.23 |
| 96160 |
|
495 |
398 |
$486.20 |
| 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 |
16 |
13 |
$332.40 |
| D1206 |
Topical application of fluoride varnish |
35 |
18 |
$302.04 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
43 |
27 |
$265.85 |
| 96127 |
|
511 |
398 |
$238.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
13 |
13 |
$160.42 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
16 |
13 |
$145.70 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
12 |
12 |
$123.39 |
| 85018 |
|
21 |
12 |
$36.38 |
| 99173 |
|
197 |
124 |
$2.00 |
| 90837 |
Psychotherapy, 53 minutes with patient |
42 |
27 |
$0.00 |
| 3078F |
|
492 |
453 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
15 |
13 |
$0.00 |
| G8431 |
Screening for depression is documented as being positive and a follow-up plan is documented |
15 |
13 |
$0.00 |
| 99080 |
|
19 |
13 |
$0.00 |
| T1013 |
Sign language or oral interpretive services, per 15 minutes |
12 |
12 |
$0.00 |
| 3074F |
|
667 |
611 |
$0.00 |
| 99406 |
|
53 |
50 |
$0.00 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
13 |
12 |
$0.00 |