| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
56,748 |
42,568 |
$6.35M |
| 99199 |
Unlisted special service, procedure or report |
202,994 |
99,324 |
$1.04M |
| T1017 |
Targeted case management, each 15 minutes |
2,687 |
2,231 |
$601K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
1,685 |
1,263 |
$105K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
2,335 |
1,750 |
$67K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
1,065 |
784 |
$64K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
890 |
640 |
$56K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
4,808 |
3,687 |
$43K |
| D0120 |
Periodic oral evaluation - established patient |
1,496 |
1,013 |
$25K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
3,583 |
2,565 |
$22K |
| 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 |
998 |
890 |
$19K |
| D1110 |
Prophylaxis - adult |
682 |
505 |
$18K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
268 |
191 |
$14K |
| D1120 |
Prophylaxis - child |
667 |
480 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
289 |
204 |
$8K |
| D1206 |
Topical application of fluoride varnish |
664 |
450 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
250 |
191 |
$6K |
| 98968 |
|
176 |
138 |
$5K |
| D0274 |
Bitewings - four radiographic images |
181 |
153 |
$4K |
| 92552 |
|
849 |
608 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
291 |
246 |
$4K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
415 |
280 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
48 |
24 |
$3K |
| 0012A |
|
90 |
76 |
$2K |
| 0071A |
|
67 |
46 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
69 |
59 |
$2K |
| 96127 |
|
2,828 |
2,100 |
$2K |
| 0011A |
|
125 |
102 |
$2K |
| 0072A |
|
48 |
37 |
$2K |
| D0330 |
Panoramic radiographic image |
35 |
29 |
$2K |
| 80305 |
|
153 |
97 |
$1K |
| 96161 |
|
800 |
571 |
$1K |
| G2211 |
Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient's single, serious condition or a complex condition. (add-on code, list separately in addition to office/outpatient evaluation and management visit, new or established) |
711 |
579 |
$1K |
| D1351 |
Sealant - per tooth |
111 |
36 |
$1K |
| 0001A |
|
48 |
26 |
$1K |
| 99173 |
|
2,234 |
1,637 |
$960.76 |
| D4355 |
|
15 |
14 |
$875.72 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
127 |
99 |
$840.47 |
| 90661 |
|
189 |
172 |
$783.60 |
| 99238 |
Hospital discharge day management, 30 minutes or less |
17 |
12 |
$743.82 |
| 0064A |
|
15 |
13 |
$700.00 |
| 99401 |
|
57 |
54 |
$585.12 |
| 96160 |
|
447 |
273 |
$530.63 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
90 |
85 |
$398.79 |
| 90474 |
|
47 |
44 |
$370.17 |
| 0031A |
|
15 |
15 |
$360.00 |
| 98960 |
|
54 |
41 |
$228.68 |
| D0272 |
Bitewings - two radiographic images |
30 |
13 |
$212.85 |
| 0002A |
|
13 |
12 |
$195.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
14 |
12 |
$174.84 |
| 90461 |
|
135 |
73 |
$146.30 |
| 90674 |
|
185 |
147 |
$143.73 |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
12 |
12 |
$136.37 |
| 81025 |
|
24 |
13 |
$88.44 |
| 85018 |
|
36 |
24 |
$52.90 |
| 81002 |
|
16 |
12 |
$37.58 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
15 |
12 |
$35.78 |
| 92551 |
|
95 |
86 |
$33.08 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
116 |
110 |
$32.11 |
| 90656 |
|
559 |
452 |
$13.75 |
| 91301 |
|
232 |
196 |
$0.01 |
| D0603 |
|
167 |
148 |
$0.00 |
| D1330 |
|
424 |
319 |
$0.00 |
| 3074F |
|
1,711 |
1,532 |
$0.00 |
| 90723 |
|
60 |
51 |
$0.00 |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
482 |
443 |
$0.00 |
| 3079F |
|
199 |
177 |
$0.00 |
| 90686 |
|
66 |
49 |
$0.00 |
| 91307 |
|
150 |
100 |
$0.00 |
| 90647 |
|
189 |
145 |
$0.00 |
| D0602 |
|
14 |
12 |
$0.00 |
| 90680 |
|
44 |
37 |
$0.00 |
| 91303 |
|
13 |
13 |
$0.00 |
| 90677 |
|
44 |
41 |
$0.00 |
| J7620 |
Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme |
12 |
12 |
$0.00 |
| 90698 |
|
12 |
12 |
$0.00 |
| 90716 |
|
15 |
12 |
$0.00 |
| 90670 |
|
680 |
466 |
$0.00 |
| 3078F |
|
1,341 |
1,219 |
$0.00 |
| 90700 |
|
300 |
207 |
$0.00 |
| 90713 |
|
83 |
69 |
$0.00 |
| 90649 |
|
17 |
12 |
$0.00 |
| 90655 |
|
87 |
63 |
$0.00 |
| 91300 |
|
125 |
94 |
$0.00 |
| 90837 |
Psychotherapy, 53 minutes with patient |
19 |
13 |
$0.00 |
| 90756 |
|
107 |
65 |
$0.00 |
| 90633 |
|
13 |
13 |
$0.00 |
| 90685 |
|
24 |
13 |
$0.00 |
| 90707 |
|
15 |
12 |
$0.00 |