| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
73,616 |
54,200 |
$11.47M |
| V2020 |
Frames, purchases |
3,680 |
3,597 |
$216K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
22,613 |
18,242 |
$197K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,867 |
2,732 |
$195K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
15,746 |
12,822 |
$181K |
| D9999 |
Unspecified adjunctive procedure, by report |
694 |
598 |
$129K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
3,054 |
2,881 |
$116K |
| S0281 |
Medical home program, comprehensive care coordination and planning, maintenance of plan |
2,191 |
2,059 |
$90K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
3,202 |
3,159 |
$85K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,113 |
1,074 |
$76K |
| 90832 |
Psychotherapy, 30 minutes with patient |
10,422 |
6,677 |
$70K |
| 92015 |
Determination of refractive state |
4,508 |
4,353 |
$66K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
8,330 |
7,020 |
$46K |
| D0140 |
Limited oral evaluation - problem focused |
2,662 |
2,308 |
$44K |
| D0330 |
Panoramic radiographic image |
1,483 |
1,323 |
$35K |
| D1120 |
Prophylaxis - child |
1,728 |
1,530 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
2,334 |
2,017 |
$16K |
| D1110 |
Prophylaxis - adult |
1,074 |
916 |
$14K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,385 |
1,216 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,218 |
1,950 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
895 |
785 |
$11K |
| 90686 |
|
783 |
700 |
$10K |
| 71046 |
Radiologic examination, chest; 2 views |
688 |
632 |
$9K |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
687 |
653 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
1,856 |
1,558 |
$8K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
110 |
91 |
$5K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
267 |
263 |
$5K |
| 90791 |
Psychiatric diagnostic evaluation |
475 |
440 |
$5K |
| 90837 |
Psychotherapy, 53 minutes with patient |
469 |
269 |
$4K |
| 90834 |
Psychotherapy, 45 minutes with patient |
299 |
235 |
$4K |
| D0272 |
Bitewings - two radiographic images |
975 |
852 |
$4K |
| 76830 |
Ultrasound, transvaginal |
73 |
73 |
$4K |
| D0274 |
Bitewings - four radiographic images |
268 |
246 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,129 |
499 |
$3K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
115 |
97 |
$3K |
| 72100 |
|
108 |
101 |
$2K |
| G0511 |
Rural health clinic or federally qualified health center (rhc or fqhc) only, general care management, 20 minutes or more of clinical staff time for chronic care management services or behavioral health integration services directed by an rhc or fqhc practitioner (physician, np, pa, or cnm), per calendar month |
2,908 |
2,418 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
32 |
25 |
$2K |
| 90853 |
Group psychotherapy (other than of a multiple-family group) |
96 |
54 |
$1K |
| 91322 |
|
13 |
13 |
$1K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
196 |
172 |
$1K |
| 74018 |
|
84 |
73 |
$1K |
| 90656 |
|
69 |
69 |
$731.52 |
| 90480 |
|
26 |
25 |
$644.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
30 |
17 |
$360.36 |
| D1206 |
Topical application of fluoride varnish |
60 |
57 |
$352.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
28 |
13 |
$332.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
33 |
28 |
$296.43 |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
1,090 |
891 |
$278.83 |
| 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 |
2,208 |
2,009 |
$194.49 |
| 73560 |
|
13 |
12 |
$185.33 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
13 |
13 |
$59.67 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
22 |
17 |
$0.00 |
| 3078F |
|
14 |
14 |
$0.00 |
| G0468 |
Federally qualified health center (fqhc) visit, ippe or awv; a fqhc visit that includes an initial preventive physical examination (ippe) or annual wellness visit (awv) and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving an ippe or awv |
12 |
12 |
$0.00 |
| 3074F |
|
221 |
184 |
$0.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
187 |
173 |
$0.00 |
| 3008F |
|
281 |
248 |
$0.00 |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
18 |
14 |
$0.00 |
| 3079F |
|
15 |
14 |
$0.00 |
| 90688 |
|
12 |
12 |
$0.00 |
| D9995 |
|
58 |
55 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
16 |
13 |
$0.00 |