| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| H1000 |
Prenatal care, at-risk assessment |
4,238 |
2,978 |
$388K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
5,753 |
4,633 |
$130K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
1,301 |
1,118 |
$83K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
1,176 |
928 |
$56K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,597 |
1,367 |
$52K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
503 |
389 |
$25K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,017 |
841 |
$20K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
4,070 |
3,231 |
$17K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
264 |
225 |
$14K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
2,096 |
1,560 |
$12K |
| 90670 |
|
572 |
380 |
$6K |
| 87428 |
|
219 |
217 |
$6K |
| 90677 |
|
205 |
190 |
$4K |
| 36415 |
Collection of venous blood by venipuncture |
2,275 |
1,873 |
$3K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
36 |
28 |
$2K |
| 99238 |
Hospital discharge day management, 30 minutes or less |
105 |
53 |
$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 |
1,938 |
1,404 |
$2K |
| 99381 |
|
15 |
14 |
$1K |
| 3074F |
|
5,045 |
4,039 |
$1K |
| 92552 |
|
137 |
132 |
$945.88 |
| 90697 |
|
141 |
138 |
$916.58 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
13 |
13 |
$790.56 |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
353 |
199 |
$714.91 |
| 90686 |
|
721 |
623 |
$694.48 |
| 90474 |
|
227 |
200 |
$680.00 |
| 1000F |
|
9,177 |
7,253 |
$643.55 |
| 81002 |
|
428 |
292 |
$572.94 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
315 |
153 |
$449.60 |
| 99401 |
|
24 |
24 |
$309.25 |
| 2010F |
|
3,241 |
2,926 |
$291.61 |
| 1159F |
|
7,144 |
5,666 |
$283.92 |
| 94760 |
|
1,248 |
876 |
$267.05 |
| 2001F |
|
12,928 |
10,345 |
$262.51 |
| 3078F |
|
4,921 |
3,726 |
$244.90 |
| 90651 |
|
36 |
24 |
$198.59 |
| 81025 |
|
103 |
72 |
$181.59 |
| 81001 |
|
665 |
469 |
$163.32 |
| 93000 |
|
18 |
14 |
$113.33 |
| 1126F |
|
5,267 |
4,234 |
$105.82 |
| 3008F |
|
8,094 |
6,364 |
$91.20 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
33 |
29 |
$90.56 |
| 99173 |
|
465 |
298 |
$88.76 |
| 1022F |
|
560 |
397 |
$76.01 |
| 1033F |
|
3,616 |
3,064 |
$73.20 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
17 |
12 |
$69.68 |
| 90710 |
|
80 |
55 |
$42.00 |
| 4040F |
|
94 |
92 |
$30.00 |
| 3044F |
|
181 |
143 |
$25.22 |
| G0439 |
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit |
44 |
31 |
$19.89 |
| 1111F |
|
1,410 |
1,290 |
$19.81 |
| 1160F |
|
6,733 |
5,336 |
$19.79 |
| G0468 |
Federally qualified health center (fqhc) visit, ippe or awv; a fqhc visit that includes an initial preventive physical examination (ippe) or annual wellness visit (awv) and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving an ippe or awv |
138 |
103 |
$12.71 |
| 2000F |
|
6,000 |
4,513 |
$12.62 |
| 85018 |
|
13 |
13 |
$12.61 |
| 90744 |
|
97 |
71 |
$12.61 |
| 90473 |
|
26 |
12 |
$10.00 |
| 1030F |
|
678 |
510 |
$0.01 |
| 1220F |
|
3,463 |
2,815 |
$0.00 |
| 4000F |
|
521 |
447 |
$0.00 |
| 90698 |
|
161 |
109 |
$0.00 |
| 4037F |
|
198 |
190 |
$0.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
60 |
48 |
$0.00 |
| 92551 |
|
380 |
220 |
$0.00 |
| 1125F |
|
12 |
12 |
$0.00 |
| 1157F |
|
293 |
128 |
$0.00 |
| 90656 |
|
80 |
78 |
$0.00 |
| 3079F |
|
56 |
42 |
$0.00 |
| 3351F |
|
70 |
25 |
$0.00 |
| 3352F |
|
57 |
12 |
$0.00 |
| 1018F |
|
1,229 |
859 |
$0.00 |
| 0502F |
|
385 |
285 |
$0.00 |
| 90633 |
|
226 |
142 |
$0.00 |
| 4035F |
|
163 |
159 |
$0.00 |
| 0521F |
|
213 |
201 |
$0.00 |
| 90734 |
|
24 |
12 |
$0.00 |
| 2028F |
|
124 |
106 |
$0.00 |
| 90700 |
|
40 |
27 |
$0.00 |
| 1158F |
|
167 |
160 |
$0.00 |
| 90681 |
|
127 |
106 |
$0.00 |
| 4148F |
|
14 |
14 |
$0.00 |
| 3210F |
|
49 |
42 |
$0.00 |
| 90715 |
|
30 |
13 |
$0.00 |