| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
74,262 |
59,150 |
$13.33M |
| 00003 |
Internal/system code - not a standard HCPCS code |
26,248 |
21,846 |
$4.95M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
25,106 |
18,876 |
$249K |
| 90834 |
Psychotherapy, 45 minutes with patient |
9,443 |
3,368 |
$230K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
16,093 |
10,528 |
$152K |
| 59425 |
|
3,719 |
2,461 |
$146K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
5,777 |
4,010 |
$106K |
| V2020 |
Frames, purchases |
8,157 |
5,691 |
$89K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
4,838 |
3,256 |
$84K |
| 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 |
5,246 |
4,673 |
$56K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
5,346 |
2,651 |
$55K |
| 0002A |
|
609 |
609 |
$41K |
| 0001A |
|
605 |
605 |
$41K |
| 92015 |
Determination of refractive state |
10,020 |
6,819 |
$35K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
802 |
457 |
$27K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
5,604 |
2,464 |
$21K |
| 90686 |
|
1,575 |
1,227 |
$21K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,773 |
1,361 |
$14K |
| G9920 |
Screening performed and negative |
1,823 |
1,216 |
$10K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
823 |
446 |
$10K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
818 |
425 |
$9K |
| 59430 |
|
163 |
147 |
$8K |
| J3490 |
Unclassified drugs |
472 |
377 |
$7K |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
248 |
179 |
$7K |
| H1003 |
Prenatal care, at-risk enhanced service; education |
528 |
233 |
$6K |
| 99000 |
|
7,377 |
5,632 |
$6K |
| 90791 |
Psychiatric diagnostic evaluation |
111 |
69 |
$6K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
753 |
433 |
$5K |
| 92551 |
|
2,919 |
2,000 |
$5K |
| J7307 |
Etonogestrel (contraceptive) implant system, including implant and supplies |
16 |
12 |
$4K |
| 81025 |
|
2,408 |
1,957 |
$4K |
| 0012A |
|
63 |
63 |
$4K |
| 0011A |
|
63 |
63 |
$4K |
| 90832 |
Psychotherapy, 30 minutes with patient |
159 |
79 |
$4K |
| 90715 |
|
190 |
118 |
$3K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
287 |
180 |
$3K |
| 99205 |
Prolong outpt/office vis |
254 |
158 |
$2K |
| 0071A |
|
36 |
36 |
$2K |
| 0004A |
|
36 |
36 |
$2K |
| V2303 |
Spherocylinder, trifocal, plano to plus or minus 4.00d sphere, .12-2.00d cylinder, per lens |
273 |
135 |
$2K |
| 0072A |
|
33 |
32 |
$2K |
| 90746 |
|
33 |
26 |
$2K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
560 |
416 |
$2K |
| 99215 |
Prolong outpt/office vis |
447 |
328 |
$2K |
| 0054A |
|
28 |
28 |
$1K |
| 0124A |
|
34 |
34 |
$1K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
7,448 |
5,658 |
$907.56 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
54 |
52 |
$743.60 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
1,078 |
786 |
$631.91 |
| 92083 |
|
78 |
50 |
$498.25 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
132 |
81 |
$495.00 |
| 85018 |
|
7,464 |
5,459 |
$475.80 |
| 81003 |
|
1,635 |
1,278 |
$459.05 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
1,020 |
820 |
$331.12 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
775 |
562 |
$314.62 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
443 |
250 |
$257.76 |
| V2744 |
Tint, photochromatic, per lens |
265 |
103 |
$233.48 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
292 |
228 |
$164.49 |
| 99401 |
|
13 |
12 |
$151.42 |
| 99188 |
|
230 |
205 |
$147.60 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
4,149 |
2,033 |
$85.60 |
| V2781 |
Progressive lens, per lens |
248 |
108 |
$60.00 |
| V2750 |
Anti-reflective coating, per lens |
249 |
111 |
$55.20 |
| 81002 |
|
547 |
472 |
$27.52 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
200 |
60 |
$10.62 |
| 3008F |
|
5,102 |
4,561 |
$0.00 |
| 3074F |
|
3,684 |
3,295 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
2,059 |
1,983 |
$0.00 |
| V2782 |
Lens, index 1.54 to 1.65 plastic or 1.60 to 1.79 glass, excludes polycarbonate, per lens |
2,137 |
809 |
$0.00 |
| 3079F |
|
1,425 |
1,354 |
$0.00 |
| 36416 |
|
2,956 |
2,371 |
$0.00 |
| Z1038 |
|
349 |
333 |
$0.00 |
| 3075F |
|
325 |
319 |
$0.00 |
| Z1034 |
|
2,728 |
1,902 |
$0.00 |
| 1111F |
|
676 |
602 |
$0.00 |
| 3080F |
|
426 |
270 |
$0.00 |
| Z6410 |
|
518 |
230 |
$0.00 |
| Z1032 |
|
287 |
287 |
$0.00 |
| 96127 |
|
13 |
13 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
26 |
26 |
$0.00 |
| 90656 |
|
44 |
44 |
$0.00 |
| 99999 |
|
52 |
32 |
$0.00 |
| 99173 |
|
2,793 |
1,854 |
$0.00 |
| 59426 |
|
640 |
356 |
$0.00 |
| 3077F |
|
924 |
664 |
$0.00 |
| 1159F |
|
15,664 |
10,678 |
$0.00 |
| 3078F |
|
2,845 |
2,575 |
$0.00 |
| 1160F |
|
15,663 |
10,677 |
$0.00 |
| 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 |
57 |
33 |
$0.00 |
| 90473 |
|
77 |
51 |
$0.00 |
| Z6400 |
|
41 |
38 |
$0.00 |
| 96160 |
|
98 |
88 |
$0.00 |
| G0101 |
Cervical or vaginal cancer screening; pelvic and clinical breast examination |
101 |
101 |
$0.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
12 |
12 |
$0.00 |
| A4649 |
Surgical supply; miscellaneous |
25 |
25 |
$0.00 |
| Z6300 |
|
12 |
12 |
$0.00 |