| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
22,955 |
16,321 |
$4.02M |
| 99199 |
Unlisted special service, procedure or report |
38,800 |
23,246 |
$198K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
670 |
468 |
$71K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
564 |
447 |
$50K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
5,052 |
3,947 |
$47K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
2,088 |
1,606 |
$37K |
| 99401 |
|
1,264 |
956 |
$24K |
| G9919 |
Screening performed and positive and provision of recommendations |
360 |
290 |
$13K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
1,621 |
1,276 |
$11K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
37 |
28 |
$6K |
| 90674 |
|
974 |
832 |
$5K |
| 90480 |
|
129 |
93 |
$4K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
70 |
54 |
$4K |
| 76856 |
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete |
68 |
61 |
$4K |
| 97802 |
|
168 |
107 |
$3K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
221 |
202 |
$3K |
| 76830 |
Ultrasound, transvaginal |
56 |
49 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
95 |
81 |
$2K |
| S0281 |
Medical home program, comprehensive care coordination and planning, maintenance of plan |
18 |
14 |
$2K |
| 90651 |
|
26 |
24 |
$2K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
140 |
126 |
$1K |
| 99383 |
|
17 |
16 |
$1K |
| 81002 |
|
400 |
336 |
$1K |
| 92551 |
|
440 |
362 |
$983.85 |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
13 |
12 |
$806.96 |
| S0280 |
Medical home program, comprehensive care coordination and planning, initial plan |
15 |
14 |
$700.00 |
| 96127 |
|
846 |
660 |
$661.62 |
| 99173 |
|
915 |
708 |
$655.71 |
| D1206 |
Topical application of fluoride varnish |
65 |
55 |
$637.64 |
| 96160 |
|
259 |
199 |
$610.17 |
| 81025 |
|
114 |
81 |
$593.34 |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
12 |
12 |
$564.41 |
| 97803 |
|
15 |
13 |
$487.22 |
| 96161 |
|
270 |
185 |
$482.46 |
| 90661 |
|
622 |
474 |
$476.29 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
58 |
46 |
$447.50 |
| 85018 |
|
117 |
107 |
$375.90 |
| 87210 |
|
85 |
74 |
$373.45 |
| 90474 |
|
90 |
73 |
$370.17 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
18 |
16 |
$341.82 |
| 90715 |
|
40 |
37 |
$186.00 |
| 3074F |
|
23,407 |
16,612 |
$159.99 |
| 90686 |
|
246 |
175 |
$134.33 |
| 83014 |
|
12 |
12 |
$99.90 |
| 90633 |
|
236 |
196 |
$36.17 |
| 36416 |
|
12 |
12 |
$6.32 |
| 3079F |
|
4,085 |
3,239 |
$1.66 |
| 3080F |
|
459 |
325 |
$0.00 |
| 3008F |
|
1,220 |
913 |
$0.00 |
| 90677 |
|
155 |
126 |
$0.00 |
| J3490 |
Unclassified drugs |
97 |
82 |
$0.00 |
| 90716 |
|
19 |
17 |
$0.00 |
| 3075F |
|
630 |
509 |
$0.00 |
| 90680 |
|
91 |
74 |
$0.00 |
| 90688 |
|
24 |
14 |
$0.00 |
| 90697 |
|
15 |
12 |
$0.00 |
| 3078F |
|
20,286 |
14,378 |
$0.00 |
| T1013 |
Sign language or oral interpretive services, per 15 minutes |
1,252 |
912 |
$0.00 |
| 3077F |
|
548 |
420 |
$0.00 |
| 90671 |
|
33 |
27 |
$0.00 |
| S9470 |
Nutritional counseling, dietitian visit |
2,017 |
1,514 |
$0.00 |
| 90670 |
|
156 |
115 |
$0.00 |