| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0280 |
Medical home program, comprehensive care coordination and planning, initial plan |
28,057 |
23,978 |
$4.14M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
4,299 |
3,320 |
$134K |
| 90832 |
Psychotherapy, 30 minutes with patient |
2,219 |
1,617 |
$109K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
3,195 |
2,707 |
$81K |
| 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 |
4,483 |
3,750 |
$56K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
884 |
746 |
$38K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
2,522 |
1,253 |
$24K |
| 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 |
4,412 |
4,039 |
$18K |
| 90834 |
Psychotherapy, 45 minutes with patient |
239 |
177 |
$17K |
| 3008F |
|
2,070 |
1,785 |
$7K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
91 |
73 |
$7K |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
550 |
436 |
$7K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
148 |
131 |
$5K |
| 3074F |
|
991 |
829 |
$3K |
| 90791 |
Psychiatric diagnostic evaluation |
27 |
24 |
$3K |
| 3078F |
|
723 |
620 |
$3K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
18 |
15 |
$2K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
18 |
12 |
$1K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
120 |
43 |
$1K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
89 |
80 |
$1K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
14 |
12 |
$1K |
| 36415 |
Collection of venous blood by venipuncture |
1,117 |
844 |
$1K |
| 90686 |
|
503 |
447 |
$1K |
| 90785 |
|
46 |
37 |
$573.76 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
34 |
34 |
$491.10 |
| 3079F |
|
141 |
108 |
$390.00 |
| 92551 |
|
30 |
28 |
$249.11 |
| 80061 |
Lipid panel |
14 |
12 |
$210.42 |
| G9005 |
Coordinated care fee, risk adjusted maintenance |
20,054 |
13,090 |
$177.10 |
| G9010 |
Coordinated care fee, risk adjusted maintenance, level 4 |
8,969 |
6,169 |
$176.84 |
| 80053 |
Comprehensive metabolic panel |
14 |
12 |
$166.04 |
| 80305 |
|
16 |
14 |
$128.95 |
| 81025 |
|
12 |
12 |
$93.96 |
| 99442 |
|
34 |
28 |
$74.70 |
| 92015 |
Determination of refractive state |
17 |
12 |
$34.66 |
| 99173 |
|
12 |
12 |
$30.00 |
| 99443 |
|
13 |
12 |
$29.88 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
15 |
12 |
$28.00 |
| 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 |
30 |
26 |
$5.42 |
| 92250 |
|
37 |
26 |
$2.94 |
| 81003 |
|
31 |
25 |
$2.51 |
| J2315 |
Injection, naltrexone, depot form, 1 mg |
16 |
13 |
$0.57 |
| G9004 |
Coordinated care fee, risk adjusted low, initial |
19,606 |
13,047 |
$0.12 |
| G9011 |
Coordinated care fee, risk adjusted maintenance, level 5 |
3,828 |
2,839 |
$0.03 |
| G9006 |
Coordinated care fee, home monitoring |
557 |
407 |
$0.00 |
| 4037F |
|
474 |
425 |
$0.00 |
| 90688 |
|
36 |
33 |
$0.00 |
| 90461 |
|
76 |
54 |
$0.00 |
| 0502F |
|
67 |
50 |
$0.00 |