| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
3,512 |
2,925 |
$643K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
18,678 |
16,764 |
$299K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
6,671 |
6,021 |
$94K |
| D0120 |
Periodic oral evaluation - established patient |
547 |
425 |
$77K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
1,359 |
1,338 |
$52K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
1,404 |
1,383 |
$49K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
2,749 |
2,705 |
$42K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
3,951 |
3,837 |
$42K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
1,082 |
1,047 |
$37K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
820 |
811 |
$33K |
| 90677 |
|
219 |
200 |
$23K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,754 |
1,737 |
$19K |
| 90651 |
|
215 |
213 |
$7K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
831 |
803 |
$6K |
| 90697 |
|
103 |
98 |
$6K |
| 90686 |
|
1,016 |
1,001 |
$6K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
248 |
240 |
$5K |
| 90734 |
|
218 |
214 |
$4K |
| 90619 |
|
40 |
39 |
$4K |
| 90670 |
|
323 |
319 |
$4K |
| 92551 |
|
882 |
881 |
$1K |
| 99383 |
|
14 |
14 |
$1K |
| 90633 |
|
428 |
411 |
$1K |
| 90715 |
|
153 |
152 |
$1K |
| 90461 |
|
91 |
89 |
$855.75 |
| 90474 |
|
81 |
80 |
$817.54 |
| 90710 |
|
16 |
16 |
$590.74 |
| 90381 |
|
13 |
12 |
$568.20 |
| 90656 |
|
102 |
102 |
$504.00 |
| D0330 |
Panoramic radiographic image |
245 |
245 |
$493.50 |
| 90680 |
|
61 |
54 |
$457.96 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
12 |
12 |
$415.79 |
| 99173 |
|
890 |
890 |
$404.62 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
188 |
185 |
$357.30 |
| 90723 |
|
56 |
55 |
$266.94 |
| 81000 |
|
488 |
435 |
$264.38 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
116 |
116 |
$250.00 |
| 90681 |
|
27 |
26 |
$241.31 |
| 90696 |
|
29 |
28 |
$236.96 |
| 90698 |
|
74 |
69 |
$171.50 |
| 82947 |
|
240 |
231 |
$132.00 |
| D0140 |
Limited oral evaluation - problem focused |
119 |
111 |
$125.00 |
| D1110 |
Prophylaxis - adult |
31 |
31 |
$93.75 |
| 3078F |
|
9,799 |
8,793 |
$64.02 |
| 3074F |
|
9,785 |
8,784 |
$54.02 |
| 90700 |
|
29 |
29 |
$52.00 |
| 85018 |
|
138 |
138 |
$47.00 |
| 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 |
223 |
177 |
$37.44 |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
28 |
25 |
$32.16 |
| 90658 |
|
14 |
14 |
$30.00 |
| 3075F |
|
1,226 |
1,122 |
$15.00 |
| 83655 |
|
13 |
13 |
$13.46 |
| 3077F |
|
789 |
705 |
$12.00 |
| 3079F |
|
1,435 |
1,321 |
$11.00 |
| 3080F |
|
425 |
389 |
$5.00 |
| 90716 |
|
42 |
39 |
$0.00 |
| 1127F |
|
969 |
937 |
$0.00 |
| 90744 |
|
18 |
17 |
$0.00 |
| 90647 |
|
15 |
15 |
$0.00 |
| 90648 |
|
29 |
28 |
$0.00 |
| 87806 |
|
164 |
164 |
$0.00 |
| D1120 |
Prophylaxis - child |
13 |
13 |
$0.00 |
| 82274 |
|
70 |
70 |
$0.00 |
| 0502F |
|
39 |
28 |
$0.00 |
| 59425 |
|
20 |
13 |
$0.00 |
| 90707 |
|
18 |
17 |
$0.00 |