| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
62,523 |
52,146 |
$5.31M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
190 |
183 |
$11K |
| D0274 |
Bitewings - four radiographic images |
263 |
240 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
184 |
177 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
104 |
99 |
$3K |
| D0330 |
Panoramic radiographic image |
51 |
51 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
28 |
25 |
$3K |
| D1110 |
Prophylaxis - adult |
27 |
27 |
$2K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
23,321 |
19,449 |
$670.30 |
| 91301 |
|
157 |
145 |
$141.30 |
| 81002 |
|
2,362 |
2,077 |
$5.58 |
| 96127 |
|
2,052 |
1,991 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
7,273 |
6,184 |
$0.00 |
| 90686 |
|
362 |
348 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
4,923 |
4,787 |
$0.00 |
| 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 |
4,864 |
2,403 |
$0.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
876 |
780 |
$0.00 |
| 92551 |
|
2,014 |
1,966 |
$0.00 |
| 90834 |
Psychotherapy, 45 minutes with patient |
498 |
330 |
$0.00 |
| 90688 |
|
1,326 |
1,168 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
180 |
110 |
$0.00 |
| 0011A |
|
29 |
29 |
$0.00 |
| 82962 |
|
1,734 |
1,317 |
$0.00 |
| D0999 |
Unspecified diagnostic procedure, by report |
2,913 |
2,687 |
$0.00 |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
1,448 |
772 |
$0.00 |
| 86580 |
|
71 |
70 |
$0.00 |
| 90680 |
|
48 |
46 |
$0.00 |
| 0064A |
|
15 |
12 |
$0.00 |
| 0012A |
|
56 |
54 |
$0.00 |
| 90647 |
|
91 |
85 |
$0.00 |
| 96161 |
|
139 |
136 |
$0.00 |
| 90723 |
|
59 |
55 |
$0.00 |
| 90474 |
|
261 |
255 |
$0.00 |
| D9995 |
|
60 |
52 |
$0.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
131 |
109 |
$0.00 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
26 |
26 |
$0.00 |
| 99173 |
|
2,146 |
2,098 |
$0.00 |
| 81025 |
|
1,698 |
1,633 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
2,687 |
2,288 |
$0.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
344 |
333 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
1,047 |
1,010 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
1,893 |
1,833 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
417 |
393 |
$0.00 |
| 11056 |
|
310 |
259 |
$0.00 |
| 11721 |
|
1,253 |
1,041 |
$0.00 |
| 90832 |
Psychotherapy, 30 minutes with patient |
363 |
276 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
645 |
623 |
$0.00 |
| D2999 |
|
273 |
241 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
721 |
707 |
$0.00 |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
190 |
180 |
$0.00 |
| 90750 |
|
20 |
18 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
174 |
169 |
$0.00 |
| 90715 |
|
66 |
63 |
$0.00 |
| 90670 |
|
289 |
259 |
$0.00 |
| D0191 |
|
622 |
606 |
$0.00 |
| 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 |
80 |
39 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
14 |
14 |
$0.00 |
| 87210 |
|
22 |
14 |
$0.00 |