| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
159,730 |
134,678 |
$45.24M |
| 00003 |
Internal/system code - not a standard HCPCS code |
20,902 |
17,627 |
$7.22M |
| 0510 |
|
17,335 |
17,208 |
$507K |
| 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 |
4,861 |
4,363 |
$221K |
| 92552 |
|
14,706 |
14,698 |
$202K |
| 90686 |
|
7,736 |
7,725 |
$56K |
| 90698 |
|
4,580 |
4,573 |
$32K |
| 90670 |
|
4,389 |
4,381 |
$28K |
| 90633 |
|
2,841 |
2,838 |
$21K |
| 90744 |
|
2,788 |
2,783 |
$19K |
| 90651 |
|
2,303 |
2,302 |
$17K |
| 90681 |
|
2,318 |
2,315 |
$15K |
| 85018 |
|
8,381 |
8,375 |
$14K |
| 83655 |
|
2,355 |
2,352 |
$14K |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
624 |
559 |
$12K |
| 90716 |
|
1,366 |
1,363 |
$10K |
| 90734 |
|
1,574 |
1,573 |
$10K |
| 90715 |
|
1,330 |
1,330 |
$10K |
| 90707 |
|
1,130 |
1,128 |
$8K |
| 90710 |
|
1,147 |
1,145 |
$6K |
| 90619 |
|
539 |
539 |
$6K |
| 90696 |
|
954 |
953 |
$6K |
| D4910 |
|
109 |
109 |
$6K |
| 90677 |
|
374 |
374 |
$4K |
| D4341 |
|
54 |
28 |
$2K |
| 90700 |
|
165 |
165 |
$929.88 |
| Z7500 |
|
13,505 |
12,499 |
$693.12 |
| D1110 |
Prophylaxis - adult |
245 |
245 |
$676.00 |
| 90648 |
|
114 |
114 |
$431.73 |
| 90381 |
|
39 |
39 |
$431.73 |
| D0274 |
Bitewings - four radiographic images |
1,064 |
1,060 |
$304.20 |
| D0120 |
Periodic oral evaluation - established patient |
2,504 |
2,488 |
$292.50 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
8,988 |
8,621 |
$221.58 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
43,577 |
38,744 |
$200.84 |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,959 |
2,915 |
$195.00 |
| 90682 |
|
16 |
16 |
$71.13 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,446 |
1,429 |
$47.27 |
| 92015 |
Determination of refractive state |
3,899 |
3,881 |
$9.85 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
3,436 |
3,433 |
$0.00 |
| T1013 |
Sign language or oral interpretive services, per 15 minutes |
3,429 |
3,187 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
296 |
296 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
4,853 |
4,849 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
4,397 |
4,346 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
2,100 |
2,068 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
4,341 |
4,197 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
4,792 |
4,791 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
712 |
648 |
$0.00 |
| D1354 |
|
37 |
36 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
2,143 |
2,134 |
$0.00 |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
1,333 |
1,316 |
$0.00 |
| 86480 |
|
131 |
131 |
$0.00 |
| 11721 |
|
344 |
337 |
$0.00 |
| 3078F |
|
7,694 |
7,367 |
$0.00 |
| G8431 |
Screening for depression is documented as being positive and a follow-up plan is documented |
1,215 |
1,207 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
292 |
263 |
$0.00 |
| D9430 |
|
1,309 |
1,242 |
$0.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
562 |
560 |
$0.00 |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
757 |
757 |
$0.00 |
| 81002 |
|
887 |
745 |
$0.00 |
| 99173 |
|
4,744 |
4,743 |
$0.00 |
| D1120 |
Prophylaxis - child |
2,911 |
2,893 |
$0.00 |
| 96158 |
|
393 |
300 |
$0.00 |
| D0270 |
|
732 |
714 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
95 |
95 |
$0.00 |
| 80061 |
Lipid panel |
47 |
47 |
$0.00 |
| 3077F |
|
623 |
613 |
$0.00 |
| G9920 |
Screening performed and negative |
177 |
177 |
$0.00 |
| D9990 |
|
1,324 |
1,228 |
$0.00 |
| 92083 |
|
55 |
55 |
$0.00 |
| 99382 |
|
55 |
55 |
$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 |
65 |
61 |
$0.00 |
| G0101 |
Cervical or vaginal cancer screening; pelvic and clinical breast examination |
37 |
37 |
$0.00 |
| 99201 |
|
241 |
239 |
$0.00 |
| 92133 |
|
55 |
55 |
$0.00 |
| 87653 |
|
16 |
16 |
$0.00 |
| 1159F |
|
89 |
87 |
$0.00 |
| 99215 |
Prolong outpt/office vis |
12 |
12 |
$0.00 |
| D0330 |
Panoramic radiographic image |
15 |
15 |
$0.00 |
| 1160F |
|
71 |
70 |
$0.00 |
| 88175 |
Cytopathology, cervical or vaginal, any reporting system; collected in preservative fluid, automated thin layer |
13 |
13 |
$0.00 |
| 88720 |
|
1,210 |
888 |
$0.00 |
| Z1034 |
|
6,969 |
5,432 |
$0.00 |
| 3074F |
|
7,607 |
7,267 |
$0.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
771 |
765 |
$0.00 |
| D1330 |
|
2,960 |
2,932 |
$0.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,440 |
1,438 |
$0.00 |
| D1351 |
Sealant - per tooth |
778 |
699 |
$0.00 |
| D1352 |
|
132 |
123 |
$0.00 |
| 96156 |
|
228 |
221 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
965 |
869 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
628 |
622 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
2,477 |
2,457 |
$0.00 |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
757 |
757 |
$0.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
1,529 |
1,522 |
$0.00 |
| Z1038 |
|
878 |
830 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
407 |
406 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
1,257 |
1,250 |
$0.00 |
| 99381 |
|
1,290 |
1,281 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
7,847 |
7,782 |
$0.00 |
| 3080F |
|
283 |
277 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
428 |
413 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
5,850 |
5,844 |
$0.00 |
| 96112 |
|
642 |
642 |
$0.00 |
| 99383 |
|
1,007 |
1,006 |
$0.00 |
| 99384 |
|
681 |
679 |
$0.00 |
| 3079F |
|
1,302 |
1,284 |
$0.00 |
| D0603 |
|
995 |
986 |
$0.00 |
| 92250 |
|
453 |
453 |
$0.00 |
| 96127 |
|
216 |
216 |
$0.00 |
| 92002 |
|
53 |
53 |
$0.00 |
| 3075F |
|
978 |
963 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
675 |
674 |
$0.00 |
| Z1032 |
|
221 |
221 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
114 |
114 |
$0.00 |
| 85027 |
|
79 |
79 |
$0.00 |
| D0602 |
|
103 |
102 |
$0.00 |
| 3008F |
|
114 |
109 |
$0.00 |
| 90474 |
|
28 |
28 |
$0.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
12 |
12 |
$0.00 |
| 82728 |
|
40 |
40 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
28 |
26 |
$0.00 |
| 87081 |
|
16 |
16 |
$0.00 |