| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
6,768 |
4,412 |
$657K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
613 |
315 |
$30K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
491 |
275 |
$25K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
209 |
111 |
$12K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,580 |
859 |
$11K |
| 87428 |
|
290 |
181 |
$10K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
541 |
281 |
$7K |
| 99199 |
Unlisted special service, procedure or report |
1,523 |
1,456 |
$5K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
483 |
349 |
$4K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
276 |
220 |
$4K |
| 36415 |
Collection of venous blood by venipuncture |
1,461 |
974 |
$2K |
| 90686 |
|
831 |
398 |
$461.70 |
| 92551 |
|
240 |
149 |
$423.35 |
| 90656 |
|
73 |
63 |
$275.62 |
| 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 |
20 |
15 |
$247.00 |
| 92552 |
|
38 |
19 |
$232.60 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
23 |
13 |
$189.41 |
| 99173 |
|
334 |
202 |
$165.32 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
25 |
14 |
$161.52 |
| 90619 |
|
84 |
41 |
$160.02 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
12 |
12 |
$88.81 |
| 81003 |
|
49 |
31 |
$78.09 |
| 90655 |
|
79 |
37 |
$46.11 |
| 3074F |
|
3,523 |
2,176 |
$3.68 |
| 3078F |
|
3,496 |
2,167 |
$3.65 |
| 1160F |
|
2,699 |
1,643 |
$3.02 |
| 1159F |
|
2,686 |
1,637 |
$3.00 |
| 1126F |
|
533 |
398 |
$0.71 |
| 1125F |
|
327 |
263 |
$0.42 |
| 3008F |
|
5,042 |
3,127 |
$0.17 |
| 3079F |
|
39 |
30 |
$0.04 |
| 90670 |
|
31 |
13 |
$0.00 |
| 2028F |
|
17 |
12 |
$0.00 |
| 3210F |
|
85 |
50 |
$0.00 |
| 91300 |
|
53 |
27 |
$0.00 |
| 2001F |
|
5,075 |
3,168 |
$0.00 |
| 1220F |
|
2,861 |
1,974 |
$0.00 |
| 2000F |
|
4,766 |
3,089 |
$0.00 |
| 1000F |
|
4,545 |
2,874 |
$0.00 |
| 3351F |
|
555 |
318 |
$0.00 |
| 90620 |
|
54 |
24 |
$0.00 |
| 90651 |
|
69 |
38 |
$0.00 |