| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
38,039 |
30,923 |
$5.77M |
| 00003 |
Internal/system code - not a standard HCPCS code |
27,582 |
20,594 |
$4.76M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
28,381 |
19,092 |
$106K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,116 |
1,367 |
$57K |
| 90834 |
Psychotherapy, 45 minutes with patient |
2,300 |
810 |
$54K |
| V2020 |
Frames, purchases |
2,879 |
1,984 |
$42K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,417 |
927 |
$34K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,075 |
1,117 |
$32K |
| 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 |
4,299 |
3,378 |
$28K |
| 59425 |
|
666 |
453 |
$28K |
| 92015 |
Determination of refractive state |
3,548 |
2,334 |
$16K |
| G9920 |
Screening performed and negative |
1,960 |
1,537 |
$13K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,716 |
890 |
$12K |
| 90837 |
Psychotherapy, 53 minutes with patient |
128 |
66 |
$9K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
793 |
556 |
$9K |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
222 |
189 |
$9K |
| 90686 |
|
596 |
449 |
$8K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
384 |
317 |
$5K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
125 |
77 |
$4K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,771 |
1,272 |
$3K |
| 0001A |
|
42 |
42 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
162 |
101 |
$2K |
| 90750 |
|
18 |
12 |
$2K |
| 0011A |
|
31 |
31 |
$2K |
| 99000 |
|
4,512 |
3,028 |
$2K |
| 0071A |
|
29 |
29 |
$2K |
| 0012A |
|
26 |
26 |
$2K |
| 0072A |
|
21 |
21 |
$1K |
| 90791 |
Psychiatric diagnostic evaluation |
21 |
15 |
$1K |
| 92551 |
|
3,134 |
2,336 |
$1K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
73 |
48 |
$988.84 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
909 |
657 |
$966.83 |
| 0002A |
|
14 |
14 |
$938.00 |
| 0004A |
|
12 |
12 |
$804.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
938 |
624 |
$723.73 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
28 |
28 |
$607.95 |
| 81025 |
|
341 |
301 |
$474.33 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
517 |
400 |
$286.42 |
| 85018 |
|
4,652 |
3,447 |
$278.66 |
| V2744 |
Tint, photochromatic, per lens |
19 |
12 |
$179.60 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
596 |
442 |
$168.13 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
4,141 |
3,249 |
$159.16 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
21 |
12 |
$83.26 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
177 |
129 |
$66.05 |
| 81003 |
|
449 |
397 |
$32.54 |
| V2750 |
Anti-reflective coating, per lens |
58 |
55 |
$17.60 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
19 |
14 |
$14.40 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
2,219 |
1,186 |
$9.00 |
| 81002 |
|
50 |
42 |
$9.00 |
| 99173 |
|
2,673 |
1,892 |
$2.30 |
| Z1034 |
|
602 |
438 |
$0.00 |
| 3074F |
|
2,252 |
2,041 |
$0.00 |
| 3075F |
|
230 |
223 |
$0.00 |
| 36416 |
|
2,271 |
1,834 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
810 |
778 |
$0.00 |
| 3008F |
|
3,201 |
2,883 |
$0.00 |
| 3079F |
|
993 |
943 |
$0.00 |
| V2782 |
Lens, index 1.54 to 1.65 plastic or 1.60 to 1.79 glass, excludes polycarbonate, per lens |
261 |
80 |
$0.00 |
| 3080F |
|
258 |
143 |
$0.00 |
| 96127 |
|
108 |
107 |
$0.00 |
| 1111F |
|
523 |
426 |
$0.00 |
| 1160F |
|
9,695 |
6,408 |
$0.00 |
| 3077F |
|
580 |
393 |
$0.00 |
| 1159F |
|
9,695 |
6,408 |
$0.00 |
| 96160 |
|
377 |
306 |
$0.00 |
| 3078F |
|
1,592 |
1,451 |
$0.00 |
| G8482 |
Influenza immunization administered or previously received |
12 |
12 |
$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 |
158 |
129 |
$0.00 |
| G0101 |
Cervical or vaginal cancer screening; pelvic and clinical breast examination |
17 |
17 |
$0.00 |
| 90832 |
Psychotherapy, 30 minutes with patient |
33 |
25 |
$0.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
120 |
30 |
$0.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
12 |
12 |
$0.00 |
| G8483 |
Influenza immunization was not administered for reasons documented by clinician (e.g., patient allergy or other medical reasons, patient declined or other patient reasons, vaccine not available or other system reasons) |
13 |
13 |
$0.00 |