Five GP practices got more than €1m each for treating medical card patients last year.
That is according to Freedom of Information figures released to Newstalk.
The total amount paid out under the scheme increased by one-third in 2020.
Over 2,900 GPs across Ireland were paid a total of €788m under the medical card scheme last year.
This includes practice support payments they received from the HSE.
Some 24 practices got over €800,000 each - with five getting at least €1m.
The practice run by Dr Anas Mansour in north-west Dublin got the most, at nearly €1.3m.
The total figure of €78m is nearly €200m more than 2019.
But Monaghan GP Dr Illona Duffy says the figures do not tell the whole story.
"The medical card scheme payments are never just a salary to a GP, they're a payment to a practice.
"And while there may be one GPs name, that doesn't necessarily give a true picture of what that money goes towards.
"And as we know, a GP practice is not just the GP - there's the full team, and that goes from the GP nurses to the receptionists, secretaries, cleaners and obviously all the payments that are required to run a business".
The HSE says last year's increase is partly down to GPs' response to the COVID-19 pandemic, along with an expanded flu campaign and extra fees arising from the 2019 GP Agreement.