| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
42,901 |
35,600 |
$4.08M |
| 00003 |
Internal/system code - not a standard HCPCS code |
7,205 |
6,137 |
$2.89M |
| 0510 |
|
6,467 |
6,441 |
$189K |
| 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 |
1,583 |
1,410 |
$66K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
16,016 |
14,316 |
$30K |
| 92552 |
|
5,309 |
5,234 |
$13K |
| 90688 |
|
1,667 |
1,626 |
$12K |
| 90698 |
|
921 |
919 |
$8K |
| 90670 |
|
945 |
930 |
$7K |
| 90686 |
|
657 |
657 |
$7K |
| 99429 |
|
257 |
256 |
$6K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
1,392 |
1,390 |
$5K |
| 90651 |
|
314 |
314 |
$3K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
1,253 |
1,250 |
$2K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
1,128 |
1,125 |
$2K |
| 96112 |
|
66 |
64 |
$1K |
| 83655 |
|
192 |
187 |
$1K |
| 85018 |
|
2,276 |
2,251 |
$1K |
| 90633 |
|
131 |
131 |
$1K |
| 90734 |
|
167 |
167 |
$940.95 |
| 90733 |
|
60 |
60 |
$664.20 |
| 90677 |
|
48 |
48 |
$531.36 |
| 90744 |
|
84 |
84 |
$464.94 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
729 |
720 |
$398.01 |
| 90715 |
|
55 |
55 |
$309.96 |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
17 |
16 |
$292.25 |
| 90681 |
|
36 |
36 |
$265.68 |
| 90619 |
|
15 |
15 |
$166.05 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
3,188 |
3,037 |
$150.96 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
60 |
45 |
$130.56 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,774 |
1,686 |
$89.04 |
| 86580 |
|
12 |
12 |
$24.78 |
| 92015 |
Determination of refractive state |
915 |
915 |
$9.85 |
| D9990 |
|
523 |
465 |
$0.00 |
| 3078F |
|
2,228 |
2,144 |
$0.00 |
| Z7500 |
|
2,530 |
2,431 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
654 |
650 |
$0.00 |
| G8431 |
Screening for depression is documented as being positive and a follow-up plan is documented |
80 |
79 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
407 |
401 |
$0.00 |
| D0270 |
|
78 |
77 |
$0.00 |
| D9430 |
|
401 |
367 |
$0.00 |
| T1013 |
Sign language or oral interpretive services, per 15 minutes |
1,157 |
1,025 |
$0.00 |
| D1120 |
Prophylaxis - child |
745 |
741 |
$0.00 |
| 99173 |
|
1,336 |
1,336 |
$0.00 |
| 99201 |
|
24 |
24 |
$0.00 |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
124 |
124 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
752 |
725 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
117 |
110 |
$0.00 |
| G9920 |
Screening performed and negative |
242 |
242 |
$0.00 |
| 1160F |
|
42 |
41 |
$0.00 |
| 3077F |
|
372 |
359 |
$0.00 |
| 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 |
14 |
13 |
$0.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
69 |
67 |
$0.00 |
| 1159F |
|
45 |
44 |
$0.00 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
26 |
26 |
$0.00 |
| D1110 |
Prophylaxis - adult |
14 |
14 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
204 |
203 |
$0.00 |
| D1330 |
|
1,087 |
1,063 |
$0.00 |
| Z1034 |
|
937 |
656 |
$0.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
468 |
465 |
$0.00 |
| 3075F |
|
450 |
437 |
$0.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
25 |
24 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,234 |
1,232 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
206 |
202 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
594 |
587 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
845 |
837 |
$0.00 |
| 3074F |
|
2,382 |
2,276 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
1,752 |
1,745 |
$0.00 |
| 3079F |
|
793 |
763 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,083 |
1,056 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
320 |
277 |
$0.00 |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
124 |
124 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
287 |
287 |
$0.00 |
| 3080F |
|
189 |
186 |
$0.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
132 |
131 |
$0.00 |
| D1351 |
Sealant - per tooth |
12 |
12 |
$0.00 |
| D0603 |
|
12 |
12 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
28 |
26 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
12 |
$0.00 |
| 3008F |
|
56 |
54 |
$0.00 |