| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
16,646 |
14,665 |
$2.24M |
| 90651 |
|
129 |
127 |
$317.32 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,693 |
2,507 |
$314.97 |
| 3077F |
|
908 |
837 |
$240.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,732 |
1,614 |
$215.00 |
| 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 |
766 |
665 |
$213.99 |
| 3079F |
|
920 |
880 |
$195.00 |
| 3080F |
|
610 |
570 |
$195.00 |
| 3074F |
|
1,697 |
1,590 |
$175.00 |
| 3078F |
|
1,796 |
1,681 |
$135.00 |
| 3075F |
|
671 |
647 |
$100.00 |
| D0120 |
Periodic oral evaluation - established patient |
118 |
116 |
$40.00 |
| D1110 |
Prophylaxis - adult |
206 |
198 |
$36.00 |
| 3044F |
|
124 |
117 |
$25.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
893 |
872 |
$10.00 |
| 90461 |
|
428 |
404 |
$10.00 |
| 83037 |
|
229 |
227 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
205 |
201 |
$0.00 |
| 99173 |
|
1,772 |
1,743 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
124 |
119 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
332 |
326 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
540 |
514 |
$0.00 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
92 |
79 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
205 |
204 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
151 |
144 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
60 |
59 |
$0.00 |
| 3046F |
|
33 |
30 |
$0.00 |
| 1160F |
|
200 |
187 |
$0.00 |
| 1159F |
|
233 |
211 |
$0.00 |
| 82948 |
|
230 |
227 |
$0.00 |
| 90734 |
|
40 |
27 |
$0.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
182 |
179 |
$0.00 |
| 90715 |
|
71 |
71 |
$0.00 |
| D1120 |
Prophylaxis - child |
20 |
19 |
$0.00 |
| 81002 |
|
82 |
77 |
$0.00 |
| 91322 |
|
48 |
48 |
$0.00 |
| G8431 |
Screening for depression is documented as being positive and a follow-up plan is documented |
24 |
24 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
59 |
55 |
$0.00 |
| D0330 |
Panoramic radiographic image |
99 |
94 |
$0.00 |
| D1999 |
|
42 |
35 |
$0.00 |
| 81025 |
|
29 |
28 |
$0.00 |
| D9110 |
|
115 |
104 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
234 |
231 |
$0.00 |
| 90633 |
|
44 |
43 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
30 |
26 |
$0.00 |
| G0444 |
Annual depression screening, 5 to 15 minutes |
25 |
25 |
$0.00 |
| 90710 |
|
14 |
13 |
$0.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
14 |
13 |
$0.00 |
| 92551 |
|
1,681 |
1,646 |
$0.00 |
| 1126F |
|
286 |
279 |
$0.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
990 |
948 |
$0.00 |
| 90686 |
|
362 |
315 |
$0.00 |
| 90677 |
|
144 |
139 |
$0.00 |
| 1125F |
|
215 |
213 |
$0.00 |
| 96127 |
|
326 |
324 |
$0.00 |
| 86580 |
|
34 |
26 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
1,035 |
980 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
71 |
39 |
$0.00 |
| 90480 |
|
50 |
50 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
121 |
113 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
224 |
215 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
165 |
165 |
$0.00 |
| 90688 |
|
38 |
30 |
$0.00 |
| 90619 |
|
94 |
94 |
$0.00 |
| 99406 |
|
12 |
12 |
$0.00 |
| 99384 |
|
12 |
12 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
54 |
50 |
$0.00 |
| 90697 |
|
27 |
24 |
$0.00 |