| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
66,015 |
53,651 |
$18.04M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
12,618 |
11,572 |
$9K |
| 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 |
1,041 |
916 |
$8K |
| 99406 |
|
1,859 |
1,764 |
$8K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
16,467 |
15,347 |
$7K |
| 99499 |
|
91 |
83 |
$2K |
| 90686 |
|
1,921 |
1,883 |
$1K |
| 0012A |
|
20 |
20 |
$646.23 |
| 0011A |
|
32 |
32 |
$540.39 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
881 |
719 |
$536.53 |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
23 |
17 |
$417.69 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
2,566 |
2,503 |
$271.64 |
| D0330 |
Panoramic radiographic image |
231 |
231 |
$252.61 |
| D1206 |
Topical application of fluoride varnish |
1,747 |
1,694 |
$144.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
321 |
185 |
$130.00 |
| 90480 |
|
13 |
13 |
$120.00 |
| 36415 |
Collection of venous blood by venipuncture |
9,349 |
9,025 |
$116.12 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
182 |
180 |
$113.94 |
| D1110 |
Prophylaxis - adult |
761 |
748 |
$108.00 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
229 |
207 |
$106.72 |
| 80305 |
|
446 |
415 |
$62.85 |
| 92558 |
|
588 |
566 |
$60.34 |
| D0120 |
Periodic oral evaluation - established patient |
846 |
821 |
$60.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
430 |
427 |
$60.00 |
| D0140 |
Limited oral evaluation - problem focused |
854 |
801 |
$55.22 |
| D0220 |
Intraoral - periapical first radiographic image |
1,032 |
989 |
$32.00 |
| 81025 |
|
523 |
490 |
$25.85 |
| 99401 |
|
544 |
517 |
$21.00 |
| 99173 |
|
757 |
732 |
$18.95 |
| D0230 |
Intraoral - periapical each additional radiographic image |
382 |
329 |
$16.00 |
| D1330 |
|
1,285 |
1,253 |
$15.00 |
| 90656 |
|
13 |
13 |
$10.00 |
| 96127 |
|
321 |
313 |
$2.57 |
| 99000 |
|
11,189 |
10,692 |
$1.98 |
| 90750 |
|
25 |
25 |
$0.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
17 |
16 |
$0.00 |
| D0270 |
|
111 |
111 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
417 |
414 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
67 |
66 |
$0.00 |
| D1354 |
|
690 |
216 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
248 |
246 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
46 |
45 |
$0.00 |
| G8427 |
Eligible clinician attests to documenting in the medical record they obtained, updated, or reviewed the patient's current medications |
637 |
578 |
$0.00 |
| 86703 |
|
194 |
188 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
76 |
71 |
$0.00 |
| 90461 |
|
204 |
156 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
102 |
98 |
$0.00 |
| 90670 |
|
12 |
12 |
$0.00 |
| D1120 |
Prophylaxis - child |
139 |
139 |
$0.00 |
| G8417 |
Bmi is documented above normal parameters and a follow-up plan is documented |
187 |
181 |
$0.00 |
| G0101 |
Cervical or vaginal cancer screening; pelvic and clinical breast examination |
13 |
13 |
$0.00 |
| 90648 |
|
13 |
13 |
$0.00 |
| G8482 |
Influenza immunization administered or previously received |
136 |
129 |
$0.00 |
| 4004F |
|
44 |
44 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
38 |
28 |
$0.00 |
| 83655 |
|
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 |
| D0191 |
|
27 |
26 |
$0.00 |
| 3008F |
|
6,851 |
6,435 |
$0.00 |
| D5899 |
|
574 |
433 |
$0.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
1,180 |
1,171 |
$0.00 |
| D1310 |
|
695 |
676 |
$0.00 |
| 96161 |
|
534 |
534 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
45 |
44 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
346 |
259 |
$0.00 |
| 91200 |
|
12 |
12 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
207 |
207 |
$0.00 |
| D1320 |
|
93 |
82 |
$0.00 |
| 36416 |
|
41 |
40 |
$0.00 |
| 90677 |
|
13 |
13 |
$0.00 |
| 85018 |
|
13 |
13 |
$0.00 |
| D9995 |
|
139 |
139 |
$0.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
12 |
12 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
12 |
$0.00 |
| 99385 |
|
14 |
14 |
$0.00 |
| 96156 |
|
12 |
12 |
$0.00 |
| 90723 |
|
13 |
12 |
$0.00 |
| D0603 |
|
13 |
13 |
$0.00 |