| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
47,599 |
37,069 |
$6.40M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
13,185 |
11,894 |
$9K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
5,806 |
5,022 |
$2K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
3,167 |
3,050 |
$686.35 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
219 |
218 |
$542.80 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
2,110 |
2,086 |
$473.28 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
853 |
841 |
$401.13 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
506 |
501 |
$358.78 |
| 92551 |
|
1,352 |
1,347 |
$323.86 |
| 90670 |
|
223 |
221 |
$260.55 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
1,082 |
1,045 |
$188.84 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
588 |
588 |
$112.01 |
| 99238 |
Hospital discharge day management, 30 minutes or less |
599 |
585 |
$102.00 |
| 90686 |
|
165 |
162 |
$94.20 |
| 3074F |
|
717 |
698 |
$90.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
1,759 |
1,713 |
$82.86 |
| 99231 |
Subsequent hospital care, per day, straightforward or low complexity |
40 |
25 |
$82.76 |
| 3078F |
|
494 |
479 |
$70.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
1,063 |
919 |
$53.69 |
| 3077F |
|
39 |
38 |
$40.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
1,046 |
1,037 |
$39.20 |
| 99460 |
|
60 |
60 |
$35.63 |
| 96127 |
|
816 |
812 |
$27.58 |
| 3079F |
|
125 |
123 |
$20.00 |
| 96161 |
|
993 |
947 |
$3.83 |
| 3288F |
|
685 |
670 |
$0.00 |
| 81002 |
|
2,833 |
2,036 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
1,764 |
1,746 |
$0.00 |
| D1110 |
Prophylaxis - adult |
619 |
616 |
$0.00 |
| 99173 |
|
1,348 |
1,341 |
$0.00 |
| D0330 |
Panoramic radiographic image |
51 |
50 |
$0.00 |
| 99307 |
|
285 |
268 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
37 |
37 |
$0.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
221 |
219 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
229 |
226 |
$0.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
119 |
118 |
$0.00 |
| 83655 |
|
26 |
26 |
$0.00 |
| 99188 |
|
145 |
145 |
$0.00 |
| D1120 |
Prophylaxis - child |
412 |
411 |
$0.00 |
| 90715 |
|
98 |
97 |
$0.00 |
| 81025 |
|
129 |
129 |
$0.00 |
| 90734 |
|
28 |
28 |
$0.00 |
| G0071 |
Payment for communication technology-based services for 5 minutes or more of a virtual (non-face-to-face) communication between an rural health clinic (rhc) or federally qualified health center (fqhc) practitioner and rhc or fqhc patient, or 5 minutes or more of remote evaluation of recorded video and/or images by an rhc or fqhc practitioner, occurring in lieu of an office visit; rhc or fqhc only |
155 |
154 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
99 |
76 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
331 |
327 |
$0.00 |
| 99222 |
Initial hospital care, per day, moderate complexity |
12 |
12 |
$0.00 |
| 31575 |
|
29 |
29 |
$0.00 |
| 90633 |
|
24 |
24 |
$0.00 |
| G2211 |
Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient's single, serious condition or a complex condition. (add-on code, list separately in addition to office/outpatient evaluation and management visit, new or established) |
59 |
57 |
$0.00 |
| G2012 |
Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion |
12 |
12 |
$0.00 |
| 90661 |
|
16 |
16 |
$0.00 |
| 11721 |
|
13 |
13 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
343 |
339 |
$0.00 |
| 90723 |
|
186 |
184 |
$0.00 |
| 90474 |
|
111 |
109 |
$0.00 |
| 90647 |
|
108 |
107 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
189 |
127 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
654 |
653 |
$0.00 |
| 90680 |
|
121 |
119 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
768 |
763 |
$0.00 |
| 90677 |
|
101 |
99 |
$0.00 |
| 99232 |
Subsequent hospital care, per day, moderate complexity |
219 |
78 |
$0.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
246 |
242 |
$0.00 |
| 99308 |
Subsequent nursing facility care, per day, straightforward |
202 |
193 |
$0.00 |
| 90674 |
|
151 |
151 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
107 |
107 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
47 |
47 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
73 |
57 |
$0.00 |
| 85018 |
|
27 |
27 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
101 |
70 |
$0.00 |
| D2331 |
|
34 |
27 |
$0.00 |
| 3075F |
|
14 |
13 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
16 |
12 |
$0.00 |