| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 00003 |
Internal/system code - not a standard HCPCS code |
34,588 |
26,270 |
$18.72M |
| T1015 |
Clinic visit/encounter, all-inclusive |
22,249 |
15,379 |
$12.21M |
| 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 |
1,894 |
1,550 |
$657K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
410 |
410 |
$232K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
353 |
350 |
$180K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
4,236 |
3,838 |
$134K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,283 |
1,160 |
$43K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
4,273 |
3,829 |
$41K |
| 90832 |
Psychotherapy, 30 minutes with patient |
213 |
118 |
$16K |
| 99215 |
Prolong outpt/office vis |
535 |
501 |
$7K |
| 0561 |
|
234 |
89 |
$5K |
| 0012A |
|
164 |
164 |
$5K |
| 92015 |
Determination of refractive state |
1,414 |
1,410 |
$4K |
| 99000 |
|
325 |
297 |
$4K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
185 |
176 |
$2K |
| 90837 |
Psychotherapy, 53 minutes with patient |
1,372 |
703 |
$2K |
| 0064A |
|
25 |
25 |
$1K |
| 0011A |
|
66 |
66 |
$965.58 |
| 0071A |
|
18 |
18 |
$720.00 |
| 0072A |
|
14 |
14 |
$560.00 |
| 36415 |
Collection of venous blood by venipuncture |
80 |
74 |
$479.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
50 |
47 |
$479.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
115 |
111 |
$479.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
228 |
222 |
$26.34 |
| D0120 |
Periodic oral evaluation - established patient |
731 |
728 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
553 |
551 |
$0.00 |
| V2799 |
Vision item or service, miscellaneous |
933 |
327 |
$0.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
203 |
203 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
632 |
486 |
$0.00 |
| 36416 |
|
192 |
187 |
$0.00 |
| 92551 |
|
28 |
28 |
$0.00 |
| 90674 |
|
13 |
13 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
131 |
117 |
$0.00 |
| 90834 |
Psychotherapy, 45 minutes with patient |
97 |
74 |
$0.00 |
| D1351 |
Sealant - per tooth |
74 |
14 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
60 |
48 |
$0.00 |
| 90688 |
|
198 |
192 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
194 |
166 |
$0.00 |
| 90686 |
|
39 |
38 |
$0.00 |
| 85018 |
|
49 |
49 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
56 |
55 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
95 |
95 |
$0.00 |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
14 |
14 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
12 |
12 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
24 |
12 |
$0.00 |
| D1310 |
|
14 |
13 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
158 |
104 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
916 |
901 |
$0.00 |
| D1120 |
Prophylaxis - child |
609 |
608 |
$0.00 |
| V2020 |
Frames, purchases |
494 |
484 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
291 |
291 |
$0.00 |
| D1110 |
Prophylaxis - adult |
240 |
240 |
$0.00 |
| 82948 |
|
38 |
38 |
$0.00 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
32 |
28 |
$0.00 |
| 90715 |
|
12 |
12 |
$0.00 |
| 85014 |
|
51 |
50 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
12 |
12 |
$0.00 |
| 81003 |
|
14 |
14 |
$0.00 |
| D9110 |
|
17 |
16 |
$0.00 |
| 99173 |
|
30 |
30 |
$0.00 |
| D4910 |
|
25 |
25 |
$0.00 |
| 90853 |
Group psychotherapy (other than of a multiple-family group) |
223 |
50 |
$0.00 |
| 90461 |
|
33 |
32 |
$0.00 |
| D9430 |
|
26 |
26 |
$0.00 |