| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
70,658 |
61,561 |
$18.99M |
| 00003 |
Internal/system code - not a standard HCPCS code |
10,120 |
8,836 |
$3.66M |
| 0510 |
|
9,702 |
9,661 |
$284K |
| 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 |
3,878 |
3,540 |
$177K |
| 92552 |
|
7,186 |
7,101 |
$106K |
| 90686 |
|
3,080 |
3,068 |
$26K |
| 90670 |
|
2,398 |
2,362 |
$19K |
| 90698 |
|
1,968 |
1,960 |
$16K |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
712 |
690 |
$14K |
| 90633 |
|
1,655 |
1,637 |
$13K |
| 83655 |
|
1,559 |
1,521 |
$10K |
| 90744 |
|
1,251 |
1,242 |
$10K |
| 85018 |
|
4,770 |
4,685 |
$9K |
| 90688 |
|
1,158 |
1,082 |
$6K |
| 90681 |
|
755 |
747 |
$6K |
| 90716 |
|
390 |
385 |
$3K |
| 90651 |
|
387 |
386 |
$3K |
| 90677 |
|
191 |
191 |
$2K |
| 90715 |
|
264 |
262 |
$2K |
| 90734 |
|
259 |
258 |
$2K |
| 90707 |
|
138 |
133 |
$1K |
| 90685 |
|
108 |
103 |
$1K |
| 90710 |
|
192 |
192 |
$896.67 |
| 90696 |
|
143 |
143 |
$841.32 |
| 90381 |
|
18 |
18 |
$199.26 |
| 90649 |
|
15 |
15 |
$166.05 |
| 96112 |
|
210 |
209 |
$143.38 |
| 90733 |
|
12 |
12 |
$132.84 |
| 90700 |
|
12 |
12 |
$132.84 |
| 90648 |
|
25 |
25 |
$132.84 |
| 86480 |
|
179 |
177 |
$108.32 |
| 92015 |
Determination of refractive state |
1,533 |
1,526 |
$29.55 |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,631 |
1,602 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
1,186 |
1,168 |
$0.00 |
| 3080F |
|
205 |
201 |
$0.00 |
| D1330 |
|
1,162 |
1,150 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
9,464 |
8,975 |
$0.00 |
| D1351 |
Sealant - per tooth |
258 |
217 |
$0.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
550 |
548 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
345 |
345 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
908 |
892 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
2,351 |
2,349 |
$0.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
330 |
330 |
$0.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
19,532 |
17,824 |
$0.00 |
| 3075F |
|
745 |
729 |
$0.00 |
| 99381 |
|
201 |
199 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
250 |
214 |
$0.00 |
| D0602 |
|
25 |
25 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
313 |
313 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
5,246 |
5,222 |
$0.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
726 |
726 |
$0.00 |
| 96127 |
|
120 |
118 |
$0.00 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
14 |
14 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
499 |
493 |
$0.00 |
| D0603 |
|
232 |
225 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
559 |
558 |
$0.00 |
| 92002 |
|
32 |
32 |
$0.00 |
| 99383 |
|
411 |
411 |
$0.00 |
| 3079F |
|
935 |
916 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
205 |
190 |
$0.00 |
| 3074F |
|
3,575 |
3,472 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
62 |
62 |
$0.00 |
| 88720 |
|
18 |
13 |
$0.00 |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
12 |
12 |
$0.00 |
| 3008F |
|
89 |
87 |
$0.00 |
| 92250 |
|
12 |
12 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
1,900 |
1,898 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
2,030 |
2,025 |
$0.00 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
672 |
664 |
$0.00 |
| D0270 |
|
553 |
547 |
$0.00 |
| G8431 |
Screening for depression is documented as being positive and a follow-up plan is documented |
754 |
742 |
$0.00 |
| 99173 |
|
1,999 |
1,997 |
$0.00 |
| Z7500 |
|
4,620 |
4,430 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
695 |
693 |
$0.00 |
| 3077F |
|
507 |
493 |
$0.00 |
| D9990 |
|
332 |
310 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
1,769 |
1,740 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
3,017 |
2,879 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
409 |
405 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
1,608 |
1,585 |
$0.00 |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
189 |
183 |
$0.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
304 |
304 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
995 |
981 |
$0.00 |
| 3078F |
|
3,642 |
3,548 |
$0.00 |
| D1120 |
Prophylaxis - child |
1,430 |
1,412 |
$0.00 |
| G9920 |
Screening performed and negative |
1,347 |
1,345 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
97 |
96 |
$0.00 |
| D9430 |
|
836 |
814 |
$0.00 |
| T1013 |
Sign language or oral interpretive services, per 15 minutes |
3,721 |
3,445 |
$0.00 |
| 11721 |
|
65 |
65 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
55 |
50 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
145 |
145 |
$0.00 |
| 85014 |
|
33 |
33 |
$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 |
70 |
61 |
$0.00 |
| 81003 |
|
15 |
12 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
35 |
29 |
$0.00 |
| 99201 |
|
151 |
150 |
$0.00 |
| 1159F |
|
43 |
43 |
$0.00 |
| 1160F |
|
40 |
40 |
$0.00 |
| 99382 |
|
51 |
51 |
$0.00 |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
12 |
12 |
$0.00 |
| G0444 |
Annual depression screening, 5 to 15 minutes |
29 |
27 |
$0.00 |