| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
59,307 |
51,818 |
$12.16M |
| 0012A |
|
559 |
559 |
$22K |
| 0011A |
|
539 |
539 |
$18K |
| 99499 |
|
1,753 |
1,544 |
$10K |
| 0064A |
|
217 |
215 |
$8K |
| 0002A |
|
205 |
205 |
$8K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
16,083 |
14,547 |
$8K |
| 0072A |
|
202 |
200 |
$8K |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
384 |
315 |
$8K |
| 0071A |
|
173 |
173 |
$6K |
| 0001A |
|
126 |
125 |
$5K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
9,819 |
8,812 |
$4K |
| 3725F |
|
1,115 |
1,090 |
$4K |
| 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 |
42 |
40 |
$2K |
| 0054A |
|
51 |
51 |
$2K |
| 90480 |
|
143 |
137 |
$1K |
| 0004A |
|
43 |
43 |
$1K |
| 3078F |
|
222 |
212 |
$1K |
| 3074F |
|
184 |
176 |
$990.00 |
| 0134A |
|
41 |
41 |
$920.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
2,690 |
2,075 |
$875.84 |
| 0124A |
|
17 |
14 |
$560.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
2,232 |
2,172 |
$523.61 |
| 3079F |
|
88 |
82 |
$490.00 |
| 90686 |
|
2,462 |
2,436 |
$426.63 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
3,447 |
3,198 |
$257.40 |
| 3075F |
|
35 |
32 |
$210.00 |
| 3077F |
|
26 |
25 |
$110.00 |
| 92551 |
|
2,249 |
2,204 |
$39.76 |
| 99173 |
|
2,763 |
2,705 |
$35.96 |
| 81025 |
|
1,691 |
1,598 |
$26.00 |
| D0120 |
Periodic oral evaluation - established patient |
225 |
224 |
$24.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
286 |
261 |
$9.60 |
| D0220 |
Intraoral - periapical first radiographic image |
381 |
379 |
$9.60 |
| D0602 |
|
113 |
113 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
319 |
318 |
$0.00 |
| 90656 |
|
241 |
241 |
$0.00 |
| D0603 |
|
369 |
366 |
$0.00 |
| D1310 |
|
641 |
633 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
127 |
127 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
188 |
153 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
386 |
385 |
$0.00 |
| D1330 |
|
1,084 |
1,061 |
$0.00 |
| 90651 |
|
58 |
56 |
$0.00 |
| 1031F |
|
100 |
100 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
526 |
524 |
$0.00 |
| 91306 |
|
27 |
27 |
$0.00 |
| 1036F |
|
53 |
53 |
$0.00 |
| 91301 |
|
176 |
175 |
$0.00 |
| D0601 |
|
27 |
27 |
$0.00 |
| 91307 |
|
15 |
15 |
$0.00 |
| D1110 |
Prophylaxis - adult |
423 |
416 |
$0.00 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
692 |
674 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
420 |
349 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
919 |
904 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
530 |
513 |
$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 |
562 |
555 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
54 |
43 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
691 |
678 |
$0.00 |
| 91322 |
|
46 |
45 |
$0.00 |
| 90461 |
|
407 |
390 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
25 |
24 |
$0.00 |
| D1120 |
Prophylaxis - child |
47 |
47 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
180 |
180 |
$0.00 |
| S9470 |
Nutritional counseling, dietitian visit |
97 |
97 |
$0.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
149 |
144 |
$0.00 |
| 97803 |
|
41 |
40 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
12 |
12 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
52 |
51 |
$0.00 |
| 91300 |
|
29 |
29 |
$0.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
14 |
13 |
$0.00 |
| 91321 |
|
13 |
13 |
$0.00 |
| 90670 |
|
12 |
12 |
$0.00 |
| 90648 |
|
13 |
13 |
$0.00 |
| 90750 |
|
12 |
12 |
$0.00 |
| 99201 |
|
12 |
12 |
$0.00 |