| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| H1000 |
Prenatal care, at-risk assessment |
205 |
146 |
$7K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
295 |
234 |
$2K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
631 |
617 |
$1K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
13 |
13 |
$825.36 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
13 |
13 |
$770.08 |
| 81001 |
|
2,480 |
1,859 |
$634.15 |
| 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 |
315 |
222 |
$563.84 |
| 2001F |
|
1,433 |
1,380 |
$315.85 |
| 1000F |
|
1,248 |
1,164 |
$266.84 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
30 |
28 |
$265.95 |
| 0502F |
|
2,228 |
1,754 |
$166.75 |
| 81025 |
|
122 |
119 |
$90.02 |
| 90686 |
|
214 |
211 |
$70.00 |
| 92552 |
|
26 |
26 |
$43.10 |
| 4035F |
|
77 |
76 |
$20.00 |
| 2010F |
|
854 |
817 |
$19.79 |
| 94760 |
|
43 |
41 |
$19.79 |
| 1160F |
|
395 |
381 |
$19.79 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
15 |
15 |
$10.00 |
| 1126F |
|
404 |
395 |
$0.01 |
| 3008F |
|
629 |
567 |
$0.01 |
| 3351F |
|
131 |
95 |
$0.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
14 |
14 |
$0.00 |
| 1030F |
|
113 |
111 |
$0.00 |
| 4037F |
|
87 |
86 |
$0.00 |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
19 |
13 |
$0.00 |
| 1111F |
|
248 |
237 |
$0.00 |
| 1022F |
|
50 |
50 |
$0.00 |
| 92551 |
|
13 |
13 |
$0.00 |
| 3352F |
|
59 |
38 |
$0.00 |
| 1033F |
|
983 |
954 |
$0.00 |
| 1159F |
|
419 |
405 |
$0.00 |
| 3511F |
|
734 |
681 |
$0.00 |
| 0521F |
|
71 |
64 |
$0.00 |
| 1158F |
|
84 |
82 |
$0.00 |
| 1018F |
|
105 |
98 |
$0.00 |
| 90715 |
|
44 |
43 |
$0.00 |
| 4040F |
|
20 |
20 |
$0.00 |
| 99173 |
|
39 |
39 |
$0.00 |