| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| H1000 |
Prenatal care, at-risk assessment |
13,933 |
11,302 |
$1.57M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
6,042 |
5,169 |
$157K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
2,320 |
2,056 |
$134K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
2,059 |
1,854 |
$113K |
| H2019 |
Therapeutic behavioral services, per 15 minutes |
2,612 |
1,904 |
$111K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
3,452 |
2,987 |
$101K |
| T1015 |
Clinic visit/encounter, all-inclusive |
1,899 |
1,520 |
$87K |
| D0210 |
Intraoral - complete series of radiographic images |
1,259 |
1,195 |
$41K |
| H0032 |
Mental health service plan development by non-physician |
515 |
486 |
$32K |
| H2017 |
Psychosocial rehabilitation services, per 15 minutes |
300 |
61 |
$32K |
| H0031 |
Mental health assessment, by non-physician |
725 |
533 |
$26K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
435 |
385 |
$25K |
| 90671 |
|
435 |
378 |
$24K |
| 59410 |
|
84 |
56 |
$23K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
466 |
425 |
$22K |
| 90670 |
|
1,276 |
1,081 |
$22K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
6,076 |
5,396 |
$17K |
| D1330 |
|
658 |
617 |
$15K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
3,121 |
2,718 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,176 |
1,125 |
$7K |
| 99442 |
|
608 |
568 |
$5K |
| 90710 |
|
182 |
166 |
$4K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
54 |
48 |
$3K |
| D1110 |
Prophylaxis - adult |
376 |
355 |
$3K |
| 3074F |
|
6,604 |
5,474 |
$3K |
| 1126F |
|
8,099 |
7,017 |
$2K |
| 36415 |
Collection of venous blood by venipuncture |
2,756 |
2,336 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
233 |
214 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
278 |
236 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
41 |
39 |
$2K |
| H0001 |
Alcohol and/or drug assessment |
53 |
51 |
$2K |
| H0020 |
Alcohol and/or drug services; methadone administration and/or service (provision of the drug by a licensed program) |
103 |
38 |
$2K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
25 |
25 |
$2K |
| 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 |
1,166 |
871 |
$1K |
| 59430 |
|
70 |
51 |
$1K |
| 99441 |
|
313 |
291 |
$1K |
| 90686 |
|
1,677 |
1,521 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
71 |
56 |
$1K |
| D4346 |
|
37 |
37 |
$1K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
14 |
14 |
$1K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
136 |
132 |
$1K |
| D1120 |
Prophylaxis - child |
157 |
149 |
$968.96 |
| 90834 |
Psychotherapy, 45 minutes with patient |
18 |
13 |
$944.61 |
| 2001F |
|
21,515 |
17,687 |
$871.77 |
| 90474 |
|
483 |
445 |
$870.00 |
| 0012A |
|
22 |
21 |
$600.00 |
| 90633 |
|
682 |
588 |
$548.37 |
| 3008F |
|
17,777 |
14,612 |
$388.94 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
106 |
102 |
$358.95 |
| D1206 |
Topical application of fluoride varnish |
240 |
225 |
$313.15 |
| 1159F |
|
10,261 |
8,651 |
$302.72 |
| 83655 |
|
85 |
49 |
$299.00 |
| D0220 |
Intraoral - periapical first radiographic image |
234 |
221 |
$289.51 |
| 59025 |
Fetal non-stress test |
30 |
12 |
$253.05 |
| 0011A |
|
19 |
18 |
$199.05 |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
49 |
36 |
$174.57 |
| 99408 |
|
23 |
22 |
$172.40 |
| 3351F |
|
4,003 |
3,220 |
$149.36 |
| 90680 |
|
147 |
137 |
$116.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
112 |
57 |
$104.96 |
| D1208 |
Topical application of fluoride, excluding varnish |
288 |
270 |
$94.00 |
| 90723 |
|
71 |
63 |
$93.00 |
| 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 |
134 |
95 |
$79.25 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
138 |
83 |
$76.00 |
| 90685 |
|
29 |
27 |
$60.00 |
| 0502F |
|
1,437 |
1,131 |
$56.07 |
| 90698 |
|
67 |
65 |
$50.00 |
| 1220F |
|
12,356 |
10,293 |
$41.68 |
| 90715 |
|
43 |
40 |
$41.39 |
| 3078F |
|
5,732 |
4,410 |
$41.34 |
| 90681 |
|
302 |
234 |
$30.00 |
| 99173 |
|
358 |
305 |
$18.62 |
| 90697 |
|
257 |
215 |
$12.00 |
| 90648 |
|
286 |
267 |
$11.00 |
| 90688 |
|
84 |
76 |
$10.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
28 |
25 |
$4.48 |
| 1033F |
|
1,003 |
733 |
$0.05 |
| 1000F |
|
8,593 |
7,096 |
$0.02 |
| 4000F |
|
1,704 |
1,526 |
$0.01 |
| 92551 |
|
283 |
241 |
$0.00 |
| 2000F |
|
7,420 |
5,887 |
$0.00 |
| 3352F |
|
1,225 |
1,008 |
$0.00 |
| 0500F |
|
320 |
292 |
$0.00 |
| 1125F |
|
265 |
206 |
$0.00 |
| 1036F |
|
1,023 |
865 |
$0.00 |
| 3044F |
|
57 |
55 |
$0.00 |
| 4037F |
|
69 |
67 |
$0.00 |
| 3292F |
|
356 |
331 |
$0.00 |
| 1157F |
|
464 |
217 |
$0.00 |
| 3079F |
|
309 |
247 |
$0.00 |
| 90656 |
|
189 |
166 |
$0.00 |
| 1030F |
|
120 |
113 |
$0.00 |
| 4010F |
|
78 |
33 |
$0.00 |
| 3075F |
|
39 |
30 |
$0.00 |
| 1022F |
|
27 |
27 |
$0.00 |
| 1160F |
|
6,172 |
5,153 |
$0.00 |
| 3293F |
|
306 |
283 |
$0.00 |
| 3210F |
|
81 |
72 |
$0.00 |
| 90700 |
|
40 |
30 |
$0.00 |
| 90658 |
|
18 |
15 |
$0.00 |
| 99374 |
|
14 |
12 |
$0.00 |
| 3077F |
|
22 |
16 |
$0.00 |