| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
12,961 |
9,238 |
$1.30M |
| 99199 |
Unlisted special service, procedure or report |
109,088 |
56,992 |
$613K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
284 |
235 |
$19K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
221 |
195 |
$16K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,240 |
1,033 |
$12K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
574 |
504 |
$10K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
129 |
101 |
$8K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
56 |
43 |
$4K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
381 |
315 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
89 |
82 |
$3K |
| S0280 |
Medical home program, comprehensive care coordination and planning, initial plan |
121 |
53 |
$3K |
| 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 |
113 |
86 |
$2K |
| 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 |
176 |
158 |
$2K |
| 96160 |
|
900 |
608 |
$2K |
| D1206 |
Topical application of fluoride varnish |
89 |
82 |
$1K |
| 0012A |
|
12 |
12 |
$455.00 |
| 0011A |
|
13 |
13 |
$336.94 |
| 90656 |
|
50 |
46 |
$74.63 |
| 92551 |
|
915 |
753 |
$65.54 |
| 99173 |
|
1,027 |
854 |
$38.00 |
| 96127 |
|
12 |
12 |
$8.98 |
| 90716 |
|
35 |
28 |
$0.00 |
| 90723 |
|
40 |
38 |
$0.00 |
| 90680 |
|
14 |
12 |
$0.00 |
| 90645 |
|
55 |
50 |
$0.00 |
| 91301 |
|
35 |
33 |
$0.00 |
| 3008F |
|
13 |
12 |
$0.00 |
| 90651 |
|
17 |
14 |
$0.00 |
| 90707 |
|
35 |
28 |
$0.00 |
| 90670 |
|
90 |
86 |
$0.00 |