| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
136,803 |
118,417 |
$40.09M |
| 00003 |
Internal/system code - not a standard HCPCS code |
4,114 |
2,858 |
$1.24M |
| D1120 |
Prophylaxis - child |
19,617 |
14,894 |
$184K |
| 90832 |
Psychotherapy, 30 minutes with patient |
8,032 |
4,550 |
$167K |
| D1208 |
Topical application of fluoride, excluding varnish |
19,280 |
14,627 |
$93K |
| D1351 |
Sealant - per tooth |
13,007 |
4,061 |
$82K |
| D0230 |
Intraoral - periapical each additional radiographic image |
90,828 |
14,634 |
$68K |
| D0120 |
Periodic oral evaluation - established patient |
20,526 |
15,633 |
$66K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
29,250 |
25,292 |
$58K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
21,573 |
18,078 |
$56K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
8,527 |
7,264 |
$52K |
| 90791 |
Psychiatric diagnostic evaluation |
1,048 |
783 |
$49K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,909 |
3,400 |
$43K |
| D0220 |
Intraoral - periapical first radiographic image |
21,645 |
15,911 |
$40K |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
715 |
544 |
$35K |
| D1310 |
|
28,389 |
22,305 |
$31K |
| D0274 |
Bitewings - four radiographic images |
13,790 |
10,594 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,590 |
2,531 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,707 |
2,107 |
$16K |
| D9999 |
Unspecified adjunctive procedure, by report |
300 |
208 |
$14K |
| D1352 |
|
2,511 |
1,386 |
$14K |
| 97810 |
|
2,397 |
944 |
$13K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
1,751 |
1,461 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
1,609 |
1,194 |
$10K |
| 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 |
510 |
451 |
$8K |
| D0603 |
|
5,268 |
3,494 |
$7K |
| 90834 |
Psychotherapy, 45 minutes with patient |
293 |
214 |
$7K |
| D0170 |
|
479 |
302 |
$6K |
| D9430 |
|
2,191 |
1,840 |
$4K |
| 99215 |
Prolong outpt/office vis |
544 |
474 |
$4K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
1,275 |
1,170 |
$3K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
1,003 |
866 |
$2K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
1,477 |
1,328 |
$2K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
608 |
534 |
$1K |
| 90837 |
Psychotherapy, 53 minutes with patient |
26 |
16 |
$1K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
1,046 |
921 |
$1K |
| D0602 |
|
372 |
312 |
$1K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
498 |
435 |
$950.37 |
| D0272 |
Bitewings - two radiographic images |
647 |
554 |
$950.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
175 |
163 |
$902.91 |
| 90656 |
|
445 |
424 |
$780.29 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
103 |
93 |
$725.00 |
| D0999 |
Unspecified diagnostic procedure, by report |
12 |
12 |
$720.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
49 |
38 |
$559.00 |
| 98940 |
|
1,969 |
974 |
$483.10 |
| 90677 |
|
1,154 |
975 |
$366.66 |
| 92551 |
|
1,234 |
1,089 |
$359.57 |
| 99383 |
|
67 |
52 |
$328.98 |
| 80305 |
|
521 |
407 |
$321.64 |
| 87811 |
Infectious agent antigen detection by immunoassay; SARS-CoV-2 (COVID-19) |
206 |
192 |
$297.94 |
| 90633 |
|
965 |
803 |
$232.42 |
| 90697 |
|
775 |
661 |
$189.96 |
| D1320 |
|
751 |
523 |
$172.50 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
898 |
831 |
$161.32 |
| 83655 |
|
243 |
211 |
$138.08 |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
180 |
170 |
$134.06 |
| 85018 |
|
1,871 |
1,678 |
$131.83 |
| 90710 |
|
470 |
399 |
$97.42 |
| D0270 |
|
102 |
70 |
$70.00 |
| 90700 |
|
217 |
174 |
$54.00 |
| 90661 |
|
127 |
118 |
$48.75 |
| 99381 |
|
41 |
39 |
$45.33 |
| 90716 |
|
116 |
90 |
$45.00 |
| 90680 |
|
165 |
156 |
$45.00 |
| 90619 |
|
294 |
259 |
$36.27 |
| 90651 |
|
417 |
376 |
$36.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
450 |
423 |
$23.22 |
| 90696 |
|
391 |
187 |
$18.00 |
| J2001 |
Injection, lidocaine hcl for intravenous infusion, 10 mg |
166 |
155 |
$9.23 |
| 90744 |
|
41 |
34 |
$9.00 |
| 90647 |
|
119 |
97 |
$9.00 |
| 90648 |
|
14 |
12 |
$9.00 |
| 90713 |
|
26 |
20 |
$9.00 |
| 90707 |
|
19 |
15 |
$9.00 |
| S9445 |
Patient education, not otherwise classified, non-physician provider, individual, per session |
16 |
13 |
$8.66 |
| 90381 |
|
37 |
29 |
$4.12 |
| 90681 |
|
31 |
23 |
$4.12 |
| 99173 |
|
1,174 |
1,065 |
$4.03 |
| 81025 |
|
438 |
427 |
$2.94 |
| 3074F |
|
21,723 |
19,026 |
$0.00 |
| 3008F |
|
29,079 |
25,235 |
$0.00 |
| 2001F |
|
29,091 |
25,246 |
$0.00 |
| D1330 |
|
19,038 |
15,292 |
$0.00 |
| 3079F |
|
4,853 |
4,362 |
$0.00 |
| Z1034 |
|
6,189 |
4,724 |
$0.00 |
| 0500F |
|
634 |
633 |
$0.00 |
| Z1032 |
|
661 |
660 |
$0.00 |
| 3075F |
|
2,253 |
2,048 |
$0.00 |
| Z6406 |
|
556 |
512 |
$0.00 |
| 3080F |
|
873 |
763 |
$0.00 |
| Z1038 |
|
301 |
284 |
$0.00 |
| D0601 |
|
207 |
206 |
$0.00 |
| D9995 |
|
220 |
136 |
$0.00 |
| 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 |
255 |
236 |
$0.00 |
| Z6410 |
|
4,393 |
2,355 |
$0.00 |
| 99000 |
|
115 |
115 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
18 |
13 |
$0.00 |
| 99441 |
|
15 |
15 |
$0.00 |
| 0503F |
|
112 |
110 |
$0.00 |
| Z6204 |
|
482 |
459 |
$0.00 |
| 99386 |
|
98 |
98 |
$0.00 |
| 99385 |
|
83 |
82 |
$0.00 |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
13 |
12 |
$0.00 |
| 90620 |
|
41 |
30 |
$0.00 |
| DSEAL |
|
13 |
13 |
$0.00 |
| 99384 |
|
13 |
13 |
$0.00 |
| 90686 |
|
22 |
16 |
$0.00 |
| 90723 |
|
16 |
15 |
$0.00 |
| J7620 |
Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme |
15 |
15 |
$0.00 |
| 3077F |
|
2,549 |
2,246 |
$0.00 |
| 3078F |
|
20,620 |
18,055 |
$0.00 |
| A4550 |
Surgical trays |
49 |
47 |
$0.00 |
| Z6400 |
|
1,213 |
1,206 |
$0.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
351 |
349 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
370 |
370 |
$0.00 |
| G0101 |
Cervical or vaginal cancer screening; pelvic and clinical breast examination |
110 |
110 |
$0.00 |
| 0502F |
|
6,018 |
4,616 |
$0.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
284 |
278 |
$0.00 |
| 90715 |
|
395 |
260 |
$0.00 |
| 82948 |
|
277 |
272 |
$0.00 |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
218 |
218 |
$0.00 |
| 90461 |
|
73 |
72 |
$0.00 |
| Z6500 |
|
881 |
880 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
147 |
144 |
$0.00 |
| 11720 |
|
20 |
18 |
$0.00 |
| J3300 |
Injection, triamcinolone acetonide, preservative free, 1 mg |
15 |
15 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
25 |
25 |
$0.00 |
| 3046F |
|
13 |
13 |
$0.00 |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
26 |
25 |
$0.00 |
| 99231 |
Subsequent hospital care, per day, straightforward or low complexity |
109 |
69 |
$0.00 |
| 99382 |
|
14 |
12 |
$0.00 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
194 |
179 |
$0.00 |
| 0120 |
|
41 |
41 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
75 |
75 |
$0.00 |
| 11721 |
|
139 |
119 |
$0.00 |
| D9993 |
|
185 |
183 |
$0.00 |
| Z6304 |
|
556 |
512 |
$0.00 |
| 9504 |
Hit antibiotic total diem |
158 |
158 |
$0.00 |
| Z6300 |
|
109 |
109 |
$0.00 |
| D0191 |
|
15 |
15 |
$0.00 |
| G0470 |
Federally qualified health center (fqhc) visit, mental health, established patient; a medically-necessary, face-to-face mental health 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 mental health visit |
40 |
27 |
$0.00 |
| 99222 |
Initial hospital care, per day, moderate complexity |
26 |
26 |
$0.00 |
| Z6414 |
|
12 |
12 |
$0.00 |