| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
48,219 |
44,232 |
$13.49M |
| 0124A |
|
177 |
174 |
$7K |
| 0134A |
|
104 |
102 |
$4K |
| 0064A |
|
97 |
96 |
$3K |
| 0002A |
|
76 |
76 |
$548.39 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
15,049 |
14,346 |
$500.26 |
| 0012A |
|
174 |
173 |
$468.39 |
| 0001A |
|
61 |
61 |
$376.94 |
| 90686 |
|
2,877 |
2,873 |
$157.03 |
| 90662 |
|
25 |
25 |
$146.80 |
| 0054A |
|
26 |
26 |
$80.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
3,687 |
3,540 |
$52.00 |
| 90656 |
|
375 |
375 |
$22.35 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,684 |
1,674 |
$10.00 |
| 81025 |
|
1,547 |
1,502 |
$4.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
3,789 |
3,761 |
$0.00 |
| 91300 |
|
46 |
46 |
$0.00 |
| 90648 |
|
826 |
822 |
$0.00 |
| 90670 |
|
625 |
625 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
1,247 |
1,234 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
272 |
271 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
873 |
858 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
783 |
778 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
582 |
576 |
$0.00 |
| 90461 |
|
1,326 |
1,317 |
$0.00 |
| 1159F |
|
153 |
139 |
$0.00 |
| 1160F |
|
153 |
139 |
$0.00 |
| 90707 |
|
157 |
157 |
$0.00 |
| 90633 |
|
357 |
354 |
$0.00 |
| 99173 |
|
1,486 |
1,479 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
75 |
75 |
$0.00 |
| D1120 |
Prophylaxis - child |
105 |
105 |
$0.00 |
| 90700 |
|
17 |
17 |
$0.00 |
| 3078F |
|
116 |
113 |
$0.00 |
| D1110 |
Prophylaxis - adult |
217 |
217 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
54 |
54 |
$0.00 |
| Q2038 |
Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (fluzone) |
42 |
42 |
$0.00 |
| 3077F |
|
29 |
29 |
$0.00 |
| 90734 |
|
14 |
14 |
$0.00 |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
25 |
25 |
$0.00 |
| 90715 |
|
13 |
12 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
34 |
33 |
$0.00 |
| 90716 |
|
236 |
235 |
$0.00 |
| 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 |
1,420 |
1,352 |
$0.00 |
| 90680 |
|
416 |
413 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
40 |
40 |
$0.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
279 |
274 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
548 |
536 |
$0.00 |
| 90619 |
|
75 |
75 |
$0.00 |
| 90677 |
|
207 |
203 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
101 |
101 |
$0.00 |
| 90723 |
|
550 |
547 |
$0.00 |
| 90651 |
|
162 |
158 |
$0.00 |
| 3079F |
|
79 |
73 |
$0.00 |
| 92551 |
|
757 |
752 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
182 |
182 |
$0.00 |
| 97802 |
|
1,274 |
1,218 |
$0.00 |
| 91301 |
|
269 |
264 |
$0.00 |
| D1330 |
|
353 |
353 |
$0.00 |
| 0011A |
|
80 |
80 |
$0.00 |
| 3008F |
|
662 |
574 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
206 |
205 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
264 |
264 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
42 |
42 |
$0.00 |
| 90620 |
|
24 |
24 |
$0.00 |
| 1111F |
|
164 |
147 |
$0.00 |
| 3074F |
|
106 |
103 |
$0.00 |
| 91305 |
|
14 |
14 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
110 |
107 |
$0.00 |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
25 |
25 |
$0.00 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
54 |
53 |
$0.00 |
| 3075F |
|
16 |
16 |
$0.00 |