| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
35,787 |
32,462 |
$10.61M |
| 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 |
893 |
704 |
$6K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
9,115 |
8,360 |
$4K |
| 0124A |
|
17 |
17 |
$600.00 |
| 0064A |
|
12 |
12 |
$120.00 |
| 90686 |
|
509 |
508 |
$48.61 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
170 |
154 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
1,707 |
1,660 |
$0.00 |
| 81025 |
|
490 |
453 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
782 |
758 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
38 |
38 |
$0.00 |
| 99173 |
|
271 |
257 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
16 |
15 |
$0.00 |
| 90461 |
|
285 |
265 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
140 |
127 |
$0.00 |
| 1159F |
|
12 |
12 |
$0.00 |
| 90648 |
|
49 |
40 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
28 |
25 |
$0.00 |
| 1160F |
|
12 |
12 |
$0.00 |
| 92551 |
|
165 |
155 |
$0.00 |
| 90656 |
|
107 |
107 |
$0.00 |
| 3008F |
|
524 |
451 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
311 |
309 |
$0.00 |
| 90677 |
|
48 |
39 |
$0.00 |
| 90723 |
|
23 |
14 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
65 |
62 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
44 |
43 |
$0.00 |
| 97802 |
|
375 |
344 |
$0.00 |
| D1330 |
|
36 |
36 |
$0.00 |
| 90680 |
|
21 |
13 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
14 |
14 |
$0.00 |
| 1111F |
|
16 |
15 |
$0.00 |