| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
2,081 |
1,697 |
$103K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,506 |
2,155 |
$88K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,548 |
1,317 |
$53K |
| H2019 |
Therapeutic behavioral services, per 15 minutes |
581 |
461 |
$26K |
| H1000 |
Prenatal care, at-risk assessment |
259 |
150 |
$25K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
334 |
322 |
$20K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
325 |
266 |
$17K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
226 |
201 |
$10K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
202 |
182 |
$8K |
| H0032 |
Mental health service plan development by non-physician |
73 |
73 |
$5K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,610 |
1,380 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
190 |
190 |
$5K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
80 |
71 |
$4K |
| H0031 |
Mental health assessment, by non-physician |
85 |
57 |
$3K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
816 |
671 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
285 |
285 |
$2K |
| 90671 |
|
26 |
24 |
$2K |
| H0020 |
Alcohol and/or drug services; methadone administration and/or service (provision of the drug by a licensed program) |
164 |
54 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
43 |
37 |
$1K |
| 1159F |
|
2,929 |
2,305 |
$1K |
| 36415 |
Collection of venous blood by venipuncture |
537 |
471 |
$625.91 |
| D1110 |
Prophylaxis - adult |
55 |
55 |
$615.20 |
| 90651 |
|
31 |
25 |
$595.91 |
| 90670 |
|
17 |
12 |
$526.87 |
| D0230 |
Intraoral - periapical each additional radiographic image |
225 |
133 |
$374.37 |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$360.86 |
| 2001F |
|
5,157 |
4,022 |
$305.59 |
| 3078F |
|
1,996 |
1,641 |
$289.67 |
| 3074F |
|
2,115 |
1,780 |
$287.61 |
| D0120 |
Periodic oral evaluation - established patient |
26 |
26 |
$239.42 |
| 90686 |
|
343 |
301 |
$199.04 |
| D0220 |
Intraoral - periapical first radiographic image |
186 |
167 |
$170.10 |
| 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 |
107 |
82 |
$101.94 |
| 80061 |
Lipid panel |
28 |
26 |
$84.44 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
34 |
31 |
$43.00 |
| 1000F |
|
2,349 |
1,888 |
$37.83 |
| 3008F |
|
4,369 |
3,388 |
$32.40 |
| 80053 |
Comprehensive metabolic panel |
29 |
27 |
$28.00 |
| 1160F |
|
2,563 |
1,975 |
$19.79 |
| 90656 |
|
18 |
18 |
$19.76 |
| 81001 |
|
26 |
25 |
$16.00 |
| 1220F |
|
1,934 |
1,643 |
$12.62 |
| 1036F |
|
566 |
432 |
$12.61 |
| 1126F |
|
1,995 |
1,728 |
$0.04 |
| 3210F |
|
16 |
12 |
$0.00 |
| 2000F |
|
1,952 |
1,608 |
$0.00 |
| 1157F |
|
257 |
95 |
$0.00 |
| 4000F |
|
376 |
355 |
$0.00 |
| 3351F |
|
90 |
76 |
$0.00 |
| 1125F |
|
13 |
12 |
$0.00 |