| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
1,722 |
1,419 |
$300K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,765 |
2,372 |
$110K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
3,870 |
3,451 |
$87K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
2,087 |
1,995 |
$26K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
944 |
909 |
$16K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
480 |
443 |
$8K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
159 |
154 |
$8K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
128 |
119 |
$6K |
| 92551 |
|
1,230 |
1,183 |
$5K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
56 |
55 |
$3K |
| 99173 |
|
1,171 |
1,127 |
$2K |
| 90686 |
|
517 |
499 |
$1K |
| 90671 |
|
12 |
12 |
$843.81 |
| 99442 |
|
56 |
47 |
$759.01 |
| 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 |
14 |
14 |
$663.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
13 |
13 |
$518.01 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
12 |
12 |
$508.19 |
| 90734 |
|
16 |
16 |
$479.00 |
| 90656 |
|
55 |
54 |
$337.46 |
| 90670 |
|
56 |
53 |
$174.00 |
| 90715 |
|
12 |
12 |
$137.72 |
| 82962 |
|
109 |
97 |
$60.89 |
| 96127 |
|
54 |
53 |
$49.10 |
| 90658 |
|
12 |
12 |
$45.41 |
| D0220 |
Intraoral - periapical first radiographic image |
38 |
38 |
$20.75 |
| 3008F |
|
153 |
149 |
$10.00 |
| D1330 |
|
13 |
13 |
$5.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
65 |
24 |
$4.00 |
| 1126F |
|
16 |
14 |
$3.00 |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$2.00 |
| 99429 |
|
92 |
92 |
$0.00 |
| 99072 |
|
37 |
37 |
$0.00 |