| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
75,288 |
50,388 |
$17.29M |
| 0011A |
|
245 |
245 |
$6K |
| 0012A |
|
190 |
187 |
$6K |
| 99442 |
|
4,889 |
4,371 |
$5K |
| D5899 |
|
535 |
405 |
$5K |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
297 |
147 |
$5K |
| 0001A |
|
113 |
113 |
$4K |
| 0064A |
|
87 |
80 |
$3K |
| 0002A |
|
82 |
81 |
$3K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
4,394 |
3,999 |
$2K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,602 |
2,386 |
$2K |
| 99443 |
|
450 |
421 |
$544.80 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
65 |
64 |
$488.25 |
| 99441 |
|
1,041 |
972 |
$466.82 |
| 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 |
28 |
12 |
$461.96 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
461 |
429 |
$397.59 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,581 |
1,376 |
$337.30 |
| S9470 |
Nutritional counseling, dietitian visit |
383 |
363 |
$230.07 |
| D1110 |
Prophylaxis - adult |
3,022 |
2,998 |
$163.20 |
| 0031A |
|
12 |
12 |
$120.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
781 |
660 |
$108.00 |
| D0120 |
Periodic oral evaluation - established patient |
3,460 |
3,440 |
$96.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
69 |
58 |
$90.37 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
52 |
52 |
$90.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,024 |
864 |
$66.00 |
| D0210 |
Intraoral - complete series of radiographic images |
780 |
778 |
$54.00 |
| 81025 |
|
330 |
297 |
$40.00 |
| D9110 |
|
869 |
848 |
$36.00 |
| D0274 |
Bitewings - four radiographic images |
1,750 |
1,738 |
$33.60 |
| 90686 |
|
243 |
239 |
$22.35 |
| D0220 |
Intraoral - periapical first radiographic image |
1,525 |
1,487 |
$9.60 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
603 |
600 |
$0.00 |
| 3008F |
|
6,655 |
6,085 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
639 |
565 |
$0.00 |
| 1111F |
|
840 |
781 |
$0.00 |
| D0601 |
|
450 |
447 |
$0.00 |
| D0603 |
|
116 |
115 |
$0.00 |
| 4010F |
|
15 |
12 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
166 |
164 |
$0.00 |
| 3079F |
|
40 |
38 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
1,044 |
1,042 |
$0.00 |
| 91301 |
|
140 |
136 |
$0.00 |
| D1351 |
Sealant - per tooth |
110 |
30 |
$0.00 |
| 3074F |
|
26 |
26 |
$0.00 |
| D0602 |
|
177 |
173 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
270 |
254 |
$0.00 |
| D2330 |
|
21 |
16 |
$0.00 |
| D1330 |
|
290 |
290 |
$0.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
37 |
28 |
$0.00 |
| D2331 |
|
75 |
60 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
24 |
24 |
$0.00 |
| 3080F |
|
13 |
13 |
$0.00 |
| 91306 |
|
33 |
33 |
$0.00 |
| D9995 |
|
12 |
12 |
$0.00 |
| 92551 |
|
12 |
12 |
$0.00 |
| 3511F |
|
762 |
695 |
$0.00 |
| D0330 |
Panoramic radiographic image |
216 |
214 |
$0.00 |
| 3077F |
|
105 |
98 |
$0.00 |
| 0502F |
|
365 |
309 |
$0.00 |
| D1120 |
Prophylaxis - child |
586 |
586 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
29 |
25 |
$0.00 |
| 90461 |
|
13 |
13 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
48 |
48 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
139 |
136 |
$0.00 |
| 3078F |
|
14 |
14 |
$0.00 |
| 99173 |
|
12 |
12 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
12 |
12 |
$0.00 |
| 99215 |
Prolong outpt/office vis |
18 |
17 |
$0.00 |