| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
94,125 |
63,370 |
$19.84M |
| 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 |
5,446 |
4,361 |
$416K |
| 90832 |
Psychotherapy, 30 minutes with patient |
17,045 |
8,108 |
$55K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
21,228 |
18,116 |
$49K |
| G0470 |
Federally qualified health center (fqhc) visit, mental health, established patient; a medically-necessary, face-to-face mental health 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 mental health visit |
1,599 |
763 |
$46K |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
677 |
482 |
$40K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
19,168 |
16,306 |
$29K |
| D1354 |
|
3,145 |
711 |
$20K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,854 |
1,597 |
$15K |
| 90791 |
Psychiatric diagnostic evaluation |
1,556 |
1,463 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
8,031 |
7,102 |
$6K |
| D0270 |
|
2,814 |
2,626 |
$6K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
209 |
209 |
$5K |
| D0274 |
Bitewings - four radiographic images |
3,974 |
3,696 |
$5K |
| 0012A |
|
178 |
176 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,131 |
2,623 |
$5K |
| G0008 |
Administration of influenza virus vaccine |
484 |
470 |
$5K |
| 90674 |
|
495 |
433 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
950 |
924 |
$4K |
| D1206 |
Topical application of fluoride varnish |
5,714 |
5,360 |
$4K |
| D0330 |
Panoramic radiographic image |
3,626 |
3,325 |
$4K |
| 81025 |
|
50 |
46 |
$4K |
| 0031A |
|
265 |
258 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,079 |
2,641 |
$4K |
| 90834 |
Psychotherapy, 45 minutes with patient |
668 |
461 |
$4K |
| 0064A |
|
107 |
98 |
$3K |
| 0011A |
|
200 |
197 |
$3K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
571 |
491 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
4,985 |
4,560 |
$3K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
1,061 |
1,008 |
$3K |
| D1351 |
Sealant - per tooth |
3,124 |
1,405 |
$3K |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
561 |
534 |
$3K |
| 0002A |
|
92 |
91 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,047 |
1,726 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
2,377 |
2,273 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,185 |
1,052 |
$2K |
| 99188 |
|
1,687 |
1,643 |
$2K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
1,287 |
1,225 |
$2K |
| G0468 |
Federally qualified health center (fqhc) visit, ippe or awv; a fqhc visit that includes an initial preventive physical examination (ippe) or annual wellness visit (awv) and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving an ippe or awv |
69 |
69 |
$2K |
| 0001A |
|
93 |
91 |
$2K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
58 |
53 |
$2K |
| D1110 |
Prophylaxis - adult |
3,415 |
3,300 |
$1K |
| D0603 |
|
558 |
450 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,487 |
3,300 |
$1K |
| D0601 |
|
207 |
173 |
$852.24 |
| D2332 |
|
316 |
265 |
$824.39 |
| 81002 |
|
48 |
43 |
$673.74 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
100 |
100 |
$658.97 |
| D1120 |
Prophylaxis - child |
3,868 |
3,574 |
$558.58 |
| D2331 |
|
313 |
242 |
$509.82 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
325 |
314 |
$454.59 |
| D1330 |
|
152 |
149 |
$451.48 |
| D2335 |
|
243 |
195 |
$411.36 |
| 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 |
102 |
102 |
$408.24 |
| 0054A |
|
12 |
12 |
$360.00 |
| 99215 |
Prolong outpt/office vis |
233 |
221 |
$319.16 |
| G0439 |
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit |
49 |
44 |
$315.28 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
21 |
20 |
$308.80 |
| D4355 |
|
57 |
57 |
$297.43 |
| D4341 |
|
431 |
243 |
$297.43 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
40 |
29 |
$297.43 |
| 90686 |
|
30 |
28 |
$284.08 |
| D2394 |
|
32 |
25 |
$284.08 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
176 |
165 |
$269.94 |
| D4342 |
|
58 |
40 |
$251.42 |
| D0272 |
Bitewings - two radiographic images |
754 |
674 |
$248.51 |
| D2330 |
|
272 |
208 |
$68.61 |
| 90661 |
|
201 |
194 |
$43.39 |
| D9993 |
|
146 |
143 |
$28.75 |
| 91322 |
|
12 |
12 |
$19.81 |
| D0602 |
|
151 |
144 |
$19.27 |
| 99408 |
|
14 |
14 |
$9.30 |
| 91303 |
|
109 |
109 |
$0.00 |
| 90732 |
|
15 |
12 |
$0.00 |
| 90651 |
|
270 |
208 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
384 |
200 |
$0.00 |
| 90636 |
|
243 |
202 |
$0.00 |
| 92551 |
|
33 |
33 |
$0.00 |
| 99205 |
Prolong outpt/office vis |
43 |
43 |
$0.00 |
| D1310 |
|
34 |
34 |
$0.00 |
| 91301 |
|
428 |
421 |
$0.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
122 |
116 |
$0.00 |
| 91306 |
|
105 |
97 |
$0.00 |
| 90656 |
|
35 |
34 |
$0.00 |
| 90619 |
|
30 |
30 |
$0.00 |
| 91305 |
|
27 |
27 |
$0.00 |
| D9944 |
|
39 |
38 |
$0.00 |
| 91300 |
|
160 |
144 |
$0.00 |
| 99173 |
|
64 |
62 |
$0.00 |
| 90715 |
|
184 |
167 |
$0.00 |
| D4910 |
|
96 |
91 |
$0.00 |
| 90750 |
|
30 |
28 |
$0.00 |
| D0190 |
|
195 |
190 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
70 |
67 |
$0.00 |
| D2950 |
|
12 |
12 |
$0.00 |