| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
87,231 |
64,269 |
$14.28M |
| 00003 |
Internal/system code - not a standard HCPCS code |
10,381 |
8,191 |
$2.01M |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
40,436 |
29,267 |
$284K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
13,858 |
12,931 |
$223K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
9,748 |
7,688 |
$208K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
452 |
447 |
$137K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
1,523 |
1,512 |
$102K |
| J7307 |
Etonogestrel (contraceptive) implant system, including implant and supplies |
113 |
113 |
$93K |
| A4267 |
Contraceptive supply, condom, male, each |
4,150 |
4,123 |
$46K |
| 98940 |
|
1,479 |
1,022 |
$37K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
2,139 |
1,727 |
$33K |
| J3490 |
Unclassified drugs |
526 |
524 |
$31K |
| 0012A |
|
503 |
360 |
$28K |
| 11981 |
|
241 |
140 |
$23K |
| 59425 |
|
515 |
375 |
$22K |
| 0011A |
|
376 |
295 |
$21K |
| S9445 |
Patient education, not otherwise classified, non-physician provider, individual, per session |
1,656 |
1,656 |
$21K |
| 0002A |
|
297 |
264 |
$19K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,730 |
2,149 |
$17K |
| 0001A |
|
267 |
241 |
$17K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
2,870 |
2,447 |
$17K |
| 99402 |
|
405 |
402 |
$13K |
| H1001 |
Prenatal care, at-risk enhanced service; antepartum management |
235 |
191 |
$13K |
| 81025 |
|
7,490 |
6,780 |
$10K |
| 0003A |
|
143 |
143 |
$9K |
| J7296 |
Levonorgestrel-releasing intrauterine contraceptive system, (kyleena), 19.5 mg |
13 |
13 |
$9K |
| 92551 |
|
3,870 |
3,348 |
$7K |
| 0013A |
|
102 |
100 |
$7K |
| 11976 |
|
153 |
93 |
$6K |
| 58300 |
|
69 |
41 |
$5K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
2,641 |
2,452 |
$5K |
| D9993 |
|
75 |
75 |
$5K |
| 0071A |
|
74 |
73 |
$5K |
| G9920 |
Screening performed and negative |
369 |
341 |
$5K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
647 |
570 |
$4K |
| 76801 |
|
1,819 |
1,510 |
$4K |
| 0072A |
|
62 |
62 |
$4K |
| 99000 |
|
20,486 |
17,947 |
$4K |
| 90686 |
|
1,339 |
1,062 |
$3K |
| D1310 |
|
75 |
75 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
349 |
345 |
$3K |
| Z1034 |
|
8,115 |
6,350 |
$2K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
181 |
142 |
$2K |
| 81002 |
|
12,449 |
9,594 |
$2K |
| 99173 |
|
3,614 |
2,949 |
$2K |
| 90832 |
Psychotherapy, 30 minutes with patient |
1,134 |
548 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
122 |
120 |
$1K |
| 90633 |
|
1,202 |
1,041 |
$1K |
| 90670 |
|
1,422 |
1,304 |
$951.75 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
125 |
105 |
$922.35 |
| 58301 |
|
28 |
14 |
$785.26 |
| 3008F |
|
2,381 |
2,058 |
$609.30 |
| 92552 |
|
743 |
734 |
$515.85 |
| 90744 |
|
919 |
857 |
$387.00 |
| 90680 |
|
887 |
824 |
$357.75 |
| 90710 |
|
269 |
225 |
$315.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
30 |
27 |
$300.68 |
| 90791 |
Psychiatric diagnostic evaluation |
133 |
86 |
$300.00 |
| 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 |
12 |
12 |
$297.12 |
| 90698 |
|
660 |
611 |
$288.00 |
| 81000 |
|
784 |
682 |
$247.32 |
| 99381 |
|
329 |
321 |
$225.30 |
| 85018 |
|
1,587 |
1,534 |
$212.68 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
104 |
101 |
$206.69 |
| D0601 |
|
598 |
594 |
$195.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
151 |
132 |
$190.35 |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
46 |
43 |
$188.64 |
| 90656 |
|
213 |
171 |
$180.00 |
| 90700 |
|
430 |
393 |
$180.00 |
| 83986 |
|
66 |
64 |
$167.64 |
| D1110 |
Prophylaxis - adult |
81 |
80 |
$155.00 |
| 90716 |
|
206 |
199 |
$144.00 |
| 99215 |
Prolong outpt/office vis |
16 |
12 |
$119.61 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
533 |
406 |
$117.00 |
| 90713 |
|
331 |
314 |
$81.00 |
| 99384 |
|
76 |
75 |
$75.25 |
| 90647 |
|
282 |
275 |
$54.00 |
| 90648 |
|
62 |
50 |
$54.00 |
| 36415 |
Collection of venous blood by venipuncture |
246 |
204 |
$48.00 |
| 90651 |
|
20 |
15 |
$27.00 |
| 3078F |
|
1,744 |
1,516 |
$27.00 |
| 90685 |
|
21 |
18 |
$27.00 |
| 90734 |
|
75 |
73 |
$18.00 |
| 90715 |
|
58 |
56 |
$18.00 |
| 90696 |
|
14 |
13 |
$9.00 |
| 90697 |
|
32 |
30 |
$9.00 |
| 90461 |
|
73 |
62 |
$9.00 |
| 90707 |
|
132 |
130 |
$9.00 |
| 86580 |
|
17 |
14 |
$6.72 |
| Z6204 |
|
565 |
537 |
$0.00 |
| Z6406 |
|
349 |
347 |
$0.00 |
| D0603 |
|
628 |
605 |
$0.00 |
| 99383 |
|
54 |
54 |
$0.00 |
| 92002 |
|
16 |
16 |
$0.00 |
| 3074F |
|
1,808 |
1,562 |
$0.00 |
| Z1032 |
|
1,506 |
1,472 |
$0.00 |
| Z6410 |
|
1,067 |
958 |
$0.00 |
| 3075F |
|
115 |
105 |
$0.00 |
| Z1038 |
|
176 |
173 |
$0.00 |
| D0602 |
|
543 |
529 |
$0.00 |
| D0001 |
|
316 |
316 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
58 |
58 |
$0.00 |
| Z6402 |
|
14 |
14 |
$0.00 |
| 90723 |
|
77 |
77 |
$0.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
13 |
13 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
31 |
29 |
$0.00 |
| 3079F |
|
242 |
213 |
$0.00 |
| 3080F |
|
15 |
15 |
$0.00 |
| 90834 |
Psychotherapy, 45 minutes with patient |
32 |
24 |
$0.00 |
| Z6500 |
|
486 |
486 |
$0.00 |
| Z6400 |
|
1,320 |
1,229 |
$0.00 |
| 4004F |
|
79 |
76 |
$0.00 |
| D9430 |
|
2,054 |
2,027 |
$0.00 |
| 92015 |
Determination of refractive state |
13 |
13 |
$0.00 |
| 1160F |
|
433 |
391 |
$0.00 |
| 99201 |
|
84 |
69 |
$0.00 |
| 3077F |
|
60 |
57 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
41 |
31 |
$0.00 |
| Z6304 |
|
378 |
371 |
$0.00 |
| 3725F |
|
52 |
51 |
$0.00 |
| 90649 |
|
70 |
70 |
$0.00 |
| S0197 |
Prenatal vitamins, 30-day supply |
79 |
77 |
$0.00 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
61 |
56 |
$0.00 |
| 90681 |
|
17 |
16 |
$0.00 |
| 0502F |
|
14 |
14 |
$0.00 |
| Z6200 |
|
17 |
17 |
$0.00 |
| D1120 |
Prophylaxis - child |
46 |
46 |
$0.00 |
| Z6300 |
|
17 |
17 |
$0.00 |
| Z6308 |
|
12 |
12 |
$0.00 |
| 99382 |
|
12 |
12 |
$0.00 |