| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
76,228 |
59,065 |
$13.49M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
35,805 |
29,292 |
$212K |
| S0281 |
Medical home program, comprehensive care coordination and planning, maintenance of plan |
2,908 |
2,800 |
$106K |
| D9999 |
Unspecified adjunctive procedure, by report |
423 |
376 |
$96K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
18,612 |
15,183 |
$51K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
3,936 |
3,519 |
$31K |
| 90686 |
|
1,634 |
1,501 |
$23K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
4,042 |
3,530 |
$20K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
959 |
783 |
$7K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
1,474 |
1,320 |
$6K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
748 |
672 |
$4K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
597 |
532 |
$3K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
607 |
538 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
405 |
375 |
$2K |
| 90832 |
Psychotherapy, 30 minutes with patient |
3,233 |
2,452 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
357 |
316 |
$2K |
| 90670 |
|
388 |
358 |
$2K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
381 |
345 |
$2K |
| 90834 |
Psychotherapy, 45 minutes with patient |
152 |
131 |
$2K |
| D1120 |
Prophylaxis - child |
226 |
211 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
268 |
240 |
$2K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
75 |
72 |
$2K |
| 90656 |
|
130 |
130 |
$1K |
| 90632 |
|
15 |
13 |
$1K |
| 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 |
3,724 |
3,095 |
$946.98 |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
142 |
136 |
$872.44 |
| D0230 |
Intraoral - periapical each additional radiographic image |
138 |
108 |
$619.97 |
| D0140 |
Limited oral evaluation - problem focused |
110 |
99 |
$455.19 |
| G0008 |
Administration of influenza virus vaccine |
234 |
226 |
$436.22 |
| D0274 |
Bitewings - four radiographic images |
118 |
111 |
$414.06 |
| D0330 |
Panoramic radiographic image |
43 |
43 |
$380.80 |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
1,954 |
1,691 |
$235.13 |
| 90688 |
|
14 |
14 |
$173.41 |
| 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 |
3,862 |
3,233 |
$98.20 |
| 90473 |
|
12 |
12 |
$86.77 |
| 92015 |
Determination of refractive state |
59 |
53 |
$45.50 |
| D1110 |
Prophylaxis - adult |
86 |
79 |
$0.00 |
| 90633 |
|
40 |
39 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
93 |
80 |
$0.00 |
| 3078F |
|
334 |
286 |
$0.00 |
| 90648 |
|
159 |
131 |
$0.00 |
| 90715 |
|
43 |
40 |
$0.00 |
| 90662 |
|
41 |
40 |
$0.00 |
| 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 |
197 |
194 |
$0.00 |
| 90710 |
|
27 |
27 |
$0.00 |
| 90791 |
Psychiatric diagnostic evaluation |
12 |
12 |
$0.00 |
| 90734 |
|
98 |
77 |
$0.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
45 |
40 |
$0.00 |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
27 |
27 |
$0.00 |
| G0439 |
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit |
259 |
206 |
$0.00 |
| 3008F |
|
385 |
351 |
$0.00 |
| 3074F |
|
422 |
365 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
51 |
47 |
$0.00 |
| 90698 |
|
43 |
42 |
$0.00 |
| 90744 |
|
14 |
14 |
$0.00 |
| 90680 |
|
34 |
32 |
$0.00 |
| 90732 |
|
13 |
12 |
$0.00 |
| 90677 |
|
38 |
38 |
$0.00 |
| 90651 |
|
15 |
14 |
$0.00 |
| 3079F |
|
27 |
27 |
$0.00 |
| 90696 |
|
12 |
12 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
20 |
13 |
$0.00 |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
14 |
13 |
$0.00 |