| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
79,080 |
64,788 |
$15.84M |
| G9012 |
Other specified case management service not elsewhere classified |
787 |
589 |
$156K |
| T1002 |
Rn services, up to 15 minutes |
211 |
123 |
$16K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
19,484 |
17,082 |
$13K |
| 0012A |
|
194 |
194 |
$8K |
| 0011A |
|
214 |
212 |
$7K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
7,545 |
6,996 |
$5K |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
3,357 |
3,088 |
$3K |
| 0064A |
|
63 |
63 |
$2K |
| 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 |
2,289 |
1,890 |
$1K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
634 |
630 |
$919.02 |
| D1330 |
|
5,205 |
5,140 |
$825.00 |
| 3079F |
|
6,571 |
6,049 |
$670.00 |
| 3077F |
|
2,102 |
1,936 |
$485.00 |
| 0031A |
|
12 |
12 |
$480.00 |
| 3074F |
|
11,692 |
10,395 |
$435.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
1,822 |
1,799 |
$427.46 |
| 92551 |
|
1,767 |
1,750 |
$367.87 |
| 3080F |
|
1,207 |
1,113 |
$360.00 |
| 90715 |
|
281 |
280 |
$345.35 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,223 |
1,130 |
$333.66 |
| 3075F |
|
2,301 |
2,176 |
$283.53 |
| 99173 |
|
1,785 |
1,767 |
$208.58 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
513 |
507 |
$174.37 |
| 3078F |
|
8,609 |
7,726 |
$150.00 |
| 90686 |
|
750 |
649 |
$129.94 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
2,564 |
2,418 |
$128.75 |
| 90633 |
|
246 |
232 |
$34.60 |
| 90461 |
|
662 |
661 |
$20.00 |
| D0140 |
Limited oral evaluation - problem focused |
1,868 |
1,714 |
$20.00 |
| 80305 |
|
1,182 |
746 |
$11.97 |
| D0220 |
Intraoral - periapical first radiographic image |
3,437 |
3,142 |
$8.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
522 |
484 |
$6.55 |
| G8417 |
Bmi is documented above normal parameters and a follow-up plan is documented |
9,572 |
8,420 |
$0.00 |
| D0191 |
|
1,680 |
1,670 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
2,039 |
2,011 |
$0.00 |
| D1120 |
Prophylaxis - child |
2,094 |
2,070 |
$0.00 |
| 97803 |
|
2,468 |
2,394 |
$0.00 |
| D0270 |
|
258 |
253 |
$0.00 |
| D1110 |
Prophylaxis - adult |
3,247 |
3,189 |
$0.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
108 |
105 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
500 |
406 |
$0.00 |
| G2012 |
Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion |
618 |
585 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
242 |
241 |
$0.00 |
| 90670 |
|
170 |
170 |
$0.00 |
| D0330 |
Panoramic radiographic image |
317 |
313 |
$0.00 |
| 90734 |
|
406 |
297 |
$0.00 |
| D2140 |
|
200 |
163 |
$0.00 |
| G8482 |
Influenza immunization administered or previously received |
45 |
44 |
$0.00 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
598 |
442 |
$0.00 |
| 90671 |
|
149 |
149 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
15 |
15 |
$0.00 |
| G8483 |
Influenza immunization was not administered for reasons documented by clinician (e.g., patient allergy or other medical reasons, patient declined or other patient reasons, vaccine not available or other system reasons) |
170 |
145 |
$0.00 |
| M1316 |
Current tobacco non-user |
49 |
48 |
$0.00 |
| 91322 |
|
23 |
23 |
$0.00 |
| D2332 |
|
45 |
39 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
25 |
25 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
12 |
12 |
$0.00 |
| 81002 |
|
12 |
12 |
$0.00 |
| 90710 |
|
41 |
41 |
$0.00 |
| 91313 |
|
12 |
12 |
$0.00 |
| 90648 |
|
12 |
12 |
$0.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
12 |
12 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,185 |
1,135 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
516 |
501 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
2,221 |
2,179 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
534 |
521 |
$0.00 |
| G8420 |
Bmi is documented within normal parameters and no follow-up plan is required |
5,513 |
4,726 |
$0.00 |
| D0602 |
|
608 |
607 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,623 |
1,390 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
133 |
125 |
$0.00 |
| D1351 |
Sealant - per tooth |
702 |
208 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
691 |
571 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
3,258 |
3,219 |
$0.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
12 |
12 |
$0.00 |
| D0603 |
|
1,545 |
1,523 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
232 |
222 |
$0.00 |
| 90680 |
|
97 |
97 |
$0.00 |
| G8418 |
Bmi is documented below normal parameters and a follow-up plan is documented |
964 |
863 |
$0.00 |
| 96127 |
|
613 |
593 |
$0.00 |
| 90651 |
|
364 |
344 |
$0.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
179 |
178 |
$0.00 |
| D2160 |
|
152 |
135 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
921 |
632 |
$0.00 |
| 90673 |
|
87 |
87 |
$0.00 |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
56 |
41 |
$0.00 |
| D2331 |
|
166 |
128 |
$0.00 |
| 90716 |
|
12 |
12 |
$0.00 |
| 91306 |
|
47 |
47 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
327 |
319 |
$0.00 |
| D2330 |
|
16 |
12 |
$0.00 |
| 90696 |
|
25 |
25 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
106 |
89 |
$0.00 |
| 91301 |
|
331 |
328 |
$0.00 |
| D2335 |
|
14 |
14 |
$0.00 |
| 96161 |
|
12 |
12 |
$0.00 |
| 90677 |
|
63 |
63 |
$0.00 |
| 91303 |
|
12 |
12 |
$0.00 |