| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
12,227 |
9,638 |
$1.32M |
| 99199 |
Unlisted special service, procedure or report |
39,492 |
22,996 |
$230K |
| D1110 |
Prophylaxis - adult |
1,145 |
1,115 |
$39K |
| D0120 |
Periodic oral evaluation - established patient |
1,193 |
1,170 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
1,137 |
1,094 |
$17K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,462 |
1,171 |
$14K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
1,139 |
1,003 |
$14K |
| D1206 |
Topical application of fluoride varnish |
788 |
762 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,041 |
895 |
$12K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
547 |
468 |
$6K |
| D0274 |
Bitewings - four radiographic images |
140 |
135 |
$4K |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
152 |
109 |
$4K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
184 |
156 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
83 |
81 |
$4K |
| D1120 |
Prophylaxis - child |
118 |
110 |
$3K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
16 |
13 |
$1K |
| 36415 |
Collection of venous blood by venipuncture |
595 |
490 |
$1K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
14 |
14 |
$1K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
136 |
128 |
$1K |
| 0011A |
|
30 |
28 |
$1K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
15 |
13 |
$1K |
| D0272 |
Bitewings - two radiographic images |
53 |
52 |
$946.52 |
| 81003 |
|
563 |
510 |
$871.95 |
| 96160 |
|
363 |
323 |
$703.74 |
| 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 |
76 |
51 |
$481.30 |
| 85018 |
|
433 |
381 |
$241.72 |
| 87807 |
|
34 |
18 |
$240.15 |
| 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 |
14 |
12 |
$204.38 |
| 92587 |
|
133 |
116 |
$180.48 |
| 90686 |
|
309 |
260 |
$74.45 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
27 |
25 |
$49.36 |
| 92551 |
|
247 |
211 |
$15.00 |
| 87081 |
|
97 |
94 |
$7.33 |
| 99173 |
|
161 |
124 |
$6.00 |
| D1330 |
|
681 |
658 |
$0.00 |
| D0602 |
|
257 |
251 |
$0.00 |
| 91301 |
|
47 |
37 |
$0.00 |
| 90688 |
|
46 |
41 |
$0.00 |
| 90620 |
|
20 |
13 |
$0.00 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
17 |
13 |
$0.00 |
| 90734 |
|
27 |
18 |
$0.00 |