| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
2,008 |
1,672 |
$127K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
1,862 |
1,415 |
$108K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
1,422 |
1,225 |
$95K |
| 99199 |
Unlisted special service, procedure or report |
17,448 |
16,289 |
$71K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
4,495 |
3,264 |
$70K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
6,873 |
5,040 |
$59K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
888 |
623 |
$49K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
3,302 |
2,578 |
$22K |
| 87430 |
|
1,450 |
1,364 |
$19K |
| D0145 |
Oral evaluation for a patient under three years of age |
329 |
302 |
$9K |
| 99383 |
|
107 |
83 |
$6K |
| 92551 |
|
6,503 |
5,130 |
$5K |
| D1206 |
Topical application of fluoride varnish |
266 |
247 |
$4K |
| 90651 |
|
1,166 |
889 |
$4K |
| 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 |
163 |
126 |
$3K |
| 90620 |
|
196 |
151 |
$2K |
| 99384 |
|
33 |
27 |
$2K |
| 85018 |
|
2,168 |
1,820 |
$2K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
146 |
137 |
$2K |
| 96127 |
|
5,257 |
4,051 |
$2K |
| 81002 |
|
406 |
336 |
$776.75 |
| 90474 |
|
66 |
55 |
$734.91 |
| 99173 |
|
6,597 |
5,148 |
$345.00 |
| 98967 |
|
19 |
15 |
$337.48 |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
12 |
12 |
$115.39 |
| 81025 |
|
25 |
16 |
$96.48 |
| 90633 |
|
627 |
510 |
$71.60 |
| 90686 |
|
1,611 |
1,130 |
$16.28 |
| 36416 |
|
1,249 |
1,130 |
$0.00 |
| 90680 |
|
47 |
45 |
$0.00 |
| 90647 |
|
598 |
387 |
$0.00 |
| 90723 |
|
558 |
372 |
$0.00 |
| 90696 |
|
73 |
58 |
$0.00 |
| 90716 |
|
15 |
13 |
$0.00 |
| J7613 |
Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg |
14 |
12 |
$0.00 |
| 90685 |
|
68 |
59 |
$0.00 |
| 90734 |
|
722 |
585 |
$0.00 |
| 90670 |
|
1,133 |
776 |
$0.00 |
| 90715 |
|
331 |
250 |
$0.00 |
| 90681 |
|
13 |
13 |
$0.00 |
| 90710 |
|
74 |
60 |
$0.00 |