| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
191,081 |
162,572 |
$40.53M |
| 0012A |
|
2,424 |
2,305 |
$92K |
| 0011A |
|
2,528 |
2,470 |
$85K |
| 0064A |
|
682 |
645 |
$26K |
| 0071A |
|
298 |
298 |
$12K |
| 0002A |
|
289 |
238 |
$11K |
| 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 |
547 |
511 |
$11K |
| 0001A |
|
288 |
274 |
$11K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
59,028 |
52,821 |
$10K |
| 0072A |
|
250 |
244 |
$10K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
43,542 |
40,224 |
$6K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
74 |
74 |
$6K |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
197 |
163 |
$3K |
| 90686 |
|
5,116 |
4,912 |
$3K |
| 0004A |
|
45 |
45 |
$2K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
14,099 |
13,395 |
$2K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
2,318 |
2,230 |
$1K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
1,103 |
1,070 |
$1K |
| 0134A |
|
40 |
40 |
$1K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
2,201 |
2,101 |
$911.22 |
| 91322 |
|
15 |
12 |
$583.68 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
4,010 |
3,832 |
$317.17 |
| 90677 |
|
269 |
253 |
$283.72 |
| 90688 |
|
14 |
14 |
$248.06 |
| 92551 |
|
3,381 |
3,262 |
$206.46 |
| 85018 |
|
2,045 |
1,933 |
$182.70 |
| 90480 |
|
32 |
24 |
$160.00 |
| 90746 |
|
12 |
12 |
$119.58 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
85 |
84 |
$78.19 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
125 |
125 |
$64.86 |
| 99173 |
|
3,857 |
3,724 |
$53.67 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
604 |
481 |
$44.21 |
| 81002 |
|
603 |
578 |
$29.06 |
| 81025 |
|
1,099 |
1,041 |
$8.00 |
| 96127 |
|
514 |
486 |
$7.76 |
| 90633 |
|
369 |
364 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
2,081 |
1,810 |
$0.00 |
| 3078F |
|
24,448 |
22,614 |
$0.00 |
| D1110 |
Prophylaxis - adult |
1,378 |
1,371 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
986 |
961 |
$0.00 |
| D1120 |
Prophylaxis - child |
1,296 |
1,285 |
$0.00 |
| G9920 |
Screening performed and negative |
4,638 |
4,334 |
$0.00 |
| 90671 |
|
32 |
32 |
$0.00 |
| 1159F |
|
141 |
122 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
1,604 |
1,529 |
$0.00 |
| 91313 |
|
14 |
14 |
$0.00 |
| 3077F |
|
2,886 |
2,692 |
$0.00 |
| G9919 |
Screening performed and positive and provision of recommendations |
2,016 |
1,904 |
$0.00 |
| D0330 |
Panoramic radiographic image |
159 |
158 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
970 |
964 |
$0.00 |
| 90670 |
|
713 |
685 |
$0.00 |
| 82948 |
|
167 |
157 |
$0.00 |
| 90734 |
|
105 |
105 |
$0.00 |
| 90707 |
|
241 |
238 |
$0.00 |
| 99177 |
|
471 |
450 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
432 |
314 |
$0.00 |
| D4910 |
|
126 |
114 |
$0.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
49 |
41 |
$0.00 |
| 90750 |
|
87 |
87 |
$0.00 |
| 91300 |
|
77 |
70 |
$0.00 |
| D4341 |
|
81 |
50 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
15 |
15 |
$0.00 |
| 1160F |
|
77 |
75 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
61 |
52 |
$0.00 |
| 90710 |
|
32 |
32 |
$0.00 |
| 87210 |
|
25 |
25 |
$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 |
24 |
24 |
$0.00 |
| 90649 |
|
12 |
12 |
$0.00 |
| D9110 |
|
14 |
14 |
$0.00 |
| 96381 |
|
15 |
15 |
$0.00 |
| D0190 |
|
19 |
14 |
$0.00 |
| D0270 |
|
13 |
12 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
592 |
585 |
$0.00 |
| 3075F |
|
3,182 |
3,010 |
$0.00 |
| 3079F |
|
13,841 |
13,060 |
$0.00 |
| 3074F |
|
30,025 |
27,785 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
536 |
356 |
$0.00 |
| 4010F |
|
2,174 |
1,984 |
$0.00 |
| 36416 |
|
3,888 |
3,282 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
1,259 |
1,227 |
$0.00 |
| 90744 |
|
174 |
174 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
297 |
296 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
2,958 |
2,938 |
$0.00 |
| 90716 |
|
271 |
262 |
$0.00 |
| 87428 |
|
181 |
179 |
$0.00 |
| 91306 |
|
255 |
253 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
605 |
454 |
$0.00 |
| 90651 |
|
572 |
571 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
222 |
222 |
$0.00 |
| 90698 |
|
792 |
769 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
1,885 |
1,873 |
$0.00 |
| 90656 |
|
261 |
261 |
$0.00 |
| 90680 |
|
581 |
564 |
$0.00 |
| D9995 |
|
655 |
650 |
$0.00 |
| 90697 |
|
109 |
98 |
$0.00 |
| 3044F |
|
12 |
12 |
$0.00 |
| 3080F |
|
257 |
247 |
$0.00 |
| D2331 |
|
40 |
28 |
$0.00 |
| 90474 |
|
116 |
106 |
$0.00 |
| 91307 |
|
206 |
200 |
$0.00 |
| 91301 |
|
25 |
25 |
$0.00 |
| 90696 |
|
24 |
24 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
19 |
13 |
$0.00 |
| D0603 |
|
129 |
127 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
28 |
28 |
$0.00 |
| 90619 |
|
37 |
36 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
12 |
12 |
$0.00 |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
29 |
28 |
$0.00 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
12 |
12 |
$0.00 |
| 93000 |
|
14 |
14 |
$0.00 |