| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
76,134 |
67,684 |
$6.57M |
| 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 |
3,605 |
3,344 |
$84K |
| 00003 |
Internal/system code - not a standard HCPCS code |
232 |
189 |
$27K |
| D1110 |
Prophylaxis - adult |
947 |
936 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,576 |
1,557 |
$15K |
| D1120 |
Prophylaxis - child |
584 |
575 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
1,010 |
988 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
1,627 |
1,561 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
576 |
566 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,809 |
1,023 |
$7K |
| D9430 |
|
796 |
744 |
$7K |
| D0274 |
Bitewings - four radiographic images |
912 |
892 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
409 |
402 |
$6K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
22,980 |
20,425 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
97 |
85 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
172 |
122 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
74 |
68 |
$2K |
| 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 |
414 |
382 |
$2K |
| 0064A |
|
80 |
74 |
$2K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
2,902 |
2,763 |
$951.14 |
| D0270 |
|
452 |
433 |
$945.00 |
| 98940 |
|
48 |
38 |
$319.36 |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
12 |
12 |
$235.80 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
15,605 |
13,847 |
$102.35 |
| 0011A |
|
172 |
165 |
$70.03 |
| 0012A |
|
118 |
114 |
$70.01 |
| 92552 |
|
2,093 |
1,921 |
$66.90 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
3,038 |
2,844 |
$62.90 |
| 97802 |
|
256 |
244 |
$60.70 |
| 99173 |
|
2,595 |
2,411 |
$48.08 |
| 90674 |
|
432 |
406 |
$28.51 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
2,741 |
2,382 |
$27.09 |
| 97803 |
|
2,049 |
1,902 |
$26.11 |
| 85018 |
|
2,423 |
2,249 |
$10.35 |
| 81002 |
|
319 |
288 |
$2.15 |
| 90686 |
|
1,015 |
894 |
$0.00 |
| 3074F |
|
12 |
12 |
$0.00 |
| 90723 |
|
97 |
96 |
$0.00 |
| 3079F |
|
12 |
12 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
231 |
218 |
$0.00 |
| 90647 |
|
68 |
66 |
$0.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
129 |
118 |
$0.00 |
| 90732 |
|
14 |
13 |
$0.00 |
| 90620 |
|
14 |
12 |
$0.00 |
| 93000 |
|
35 |
25 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
15 |
15 |
$0.00 |
| 86580 |
|
12 |
12 |
$0.00 |
| 99401 |
|
3,041 |
2,850 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
188 |
169 |
$0.00 |
| 90710 |
|
12 |
12 |
$0.00 |
| 83037 |
|
383 |
364 |
$0.00 |
| 88147 |
|
230 |
212 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
121 |
105 |
$0.00 |
| 90670 |
|
112 |
112 |
$0.00 |
| 90791 |
Psychiatric diagnostic evaluation |
28 |
28 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
66 |
65 |
$0.00 |
| 90715 |
|
17 |
14 |
$0.00 |
| 81025 |
|
196 |
174 |
$0.00 |
| 59425 |
|
53 |
39 |
$0.00 |
| 82947 |
|
31 |
29 |
$0.00 |
| 90734 |
|
38 |
31 |
$0.00 |
| Q0091 |
Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory |
54 |
47 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
44 |
41 |
$0.00 |
| 90649 |
|
45 |
38 |
$0.00 |
| 0013A |
|
19 |
19 |
$0.00 |
| 90633 |
|
28 |
28 |
$0.00 |