| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| H1000 |
Prenatal care, at-risk assessment |
7,366 |
6,048 |
$743K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
5,414 |
4,374 |
$204K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
1,477 |
1,231 |
$105K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
1,532 |
1,315 |
$93K |
| D0120 |
Periodic oral evaluation - established patient |
1,684 |
1,666 |
$73K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
540 |
470 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
482 |
479 |
$20K |
| 59409 |
Vaginal delivery only (with or without episiotomy and/or forceps) |
29 |
26 |
$14K |
| 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 |
1,347 |
1,044 |
$7K |
| D1351 |
Sealant - per tooth |
434 |
124 |
$6K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
90 |
82 |
$6K |
| D1110 |
Prophylaxis - adult |
117 |
116 |
$6K |
| D1206 |
Topical application of fluoride varnish |
2,119 |
2,098 |
$5K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
94 |
79 |
$5K |
| 99381 |
|
44 |
44 |
$5K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
127 |
123 |
$4K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
1,293 |
1,053 |
$4K |
| D1120 |
Prophylaxis - child |
1,463 |
1,448 |
$3K |
| 99188 |
|
720 |
510 |
$3K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
2,145 |
1,726 |
$3K |
| 99238 |
Hospital discharge day management, 30 minutes or less |
69 |
65 |
$2K |
| 59430 |
|
76 |
69 |
$2K |
| D1330 |
|
2,280 |
2,258 |
$2K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
41 |
41 |
$2K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
29 |
29 |
$1K |
| 85018 |
|
1,912 |
1,713 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
25 |
22 |
$1K |
| D0272 |
Bitewings - two radiographic images |
561 |
556 |
$618.76 |
| 81002 |
|
1,285 |
840 |
$604.15 |
| 99231 |
Subsequent hospital care, per day, straightforward or low complexity |
32 |
30 |
$589.93 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
34 |
34 |
$350.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
26 |
25 |
$301.03 |
| 81025 |
|
147 |
137 |
$242.76 |
| 90658 |
|
21 |
21 |
$163.30 |
| 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 |
324 |
249 |
$159.94 |
| 82962 |
|
201 |
158 |
$142.49 |
| 90474 |
|
27 |
27 |
$135.00 |
| 90688 |
|
104 |
102 |
$117.74 |
| 90657 |
|
15 |
15 |
$48.99 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
17 |
15 |
$40.00 |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
13 |
13 |
$21.40 |
| 81003 |
|
18 |
18 |
$18.98 |
| 90671 |
|
200 |
196 |
$10.00 |
| 97803 |
|
1,592 |
1,283 |
$0.01 |
| 1036F |
|
3,879 |
2,753 |
$0.00 |
| 1125F |
|
629 |
517 |
$0.00 |
| 1126F |
|
7,321 |
5,840 |
$0.00 |
| 90686 |
|
368 |
294 |
$0.00 |
| 90698 |
|
565 |
415 |
$0.00 |
| 90680 |
|
703 |
569 |
$0.00 |
| 1170F |
|
949 |
615 |
$0.00 |
| 3008F |
|
10,193 |
7,569 |
$0.00 |
| 3074F |
|
6,387 |
5,170 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
706 |
539 |
$0.00 |
| G0447 |
Face-to-face behavioral counseling for obesity, 15 minutes |
1,970 |
1,593 |
$0.00 |
| 3079F |
|
222 |
187 |
$0.00 |
| 2001F |
|
268 |
252 |
$0.00 |
| 1035F |
|
131 |
110 |
$0.00 |
| 2000F |
|
163 |
151 |
$0.00 |
| 90744 |
|
262 |
164 |
$0.00 |
| 1220F |
|
101 |
89 |
$0.00 |
| 90716 |
|
51 |
51 |
$0.00 |
| 90677 |
|
38 |
38 |
$0.00 |
| 3075F |
|
12 |
12 |
$0.00 |
| 90651 |
|
28 |
28 |
$0.00 |
| 1034F |
|
266 |
209 |
$0.00 |
| 1000F |
|
91 |
80 |
$0.00 |
| 97802 |
|
16 |
16 |
$0.00 |
| 90697 |
|
50 |
46 |
$0.00 |
| 90656 |
|
49 |
49 |
$0.00 |
| 90674 |
|
22 |
22 |
$0.00 |
| 3288F |
|
3,689 |
2,699 |
$0.00 |
| 1159F |
|
6,833 |
5,467 |
$0.00 |
| 1160F |
|
6,824 |
5,468 |
$0.00 |
| 3725F |
|
5,473 |
3,724 |
$0.00 |
| 90633 |
|
318 |
256 |
$0.00 |
| 3078F |
|
6,475 |
4,849 |
$0.00 |
| 96160 |
|
27 |
26 |
$0.00 |
| 3077F |
|
14 |
14 |
$0.00 |
| 90670 |
|
764 |
598 |
$0.00 |
| 90648 |
|
12 |
12 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
17 |
16 |
$0.00 |
| 90707 |
|
25 |
25 |
$0.00 |
| 90700 |
|
13 |
13 |
$0.00 |