| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
6,752 |
4,814 |
$893K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
9,121 |
7,094 |
$167K |
| 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 |
2,142 |
1,588 |
$55K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,060 |
840 |
$24K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,235 |
1,025 |
$18K |
| 0012A |
|
177 |
166 |
$5K |
| 98940 |
|
2,889 |
1,867 |
$4K |
| 0001A |
|
147 |
140 |
$3K |
| 99000 |
|
1,187 |
976 |
$3K |
| 91320 |
|
44 |
36 |
$3K |
| 0002A |
|
136 |
132 |
$2K |
| 0011A |
|
161 |
155 |
$2K |
| 90686 |
|
313 |
276 |
$2K |
| 0071A |
|
92 |
49 |
$2K |
| 0072A |
|
80 |
49 |
$2K |
| 87636 |
Infectious agent detection by nucleic acid; SARS-CoV-2 and influenza virus types A and B |
12 |
12 |
$1K |
| 90834 |
Psychotherapy, 45 minutes with patient |
58 |
27 |
$1K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
15 |
14 |
$815.77 |
| 0064A |
|
32 |
27 |
$784.72 |
| 0003A |
|
18 |
18 |
$128.64 |
| 36416 |
|
130 |
105 |
$78.06 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
257 |
238 |
$56.42 |
| 87400 |
|
18 |
12 |
$52.29 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
14 |
13 |
$39.63 |
| 36415 |
Collection of venous blood by venipuncture |
265 |
225 |
$33.82 |
| D1110 |
Prophylaxis - adult |
193 |
142 |
$0.00 |
| D1120 |
Prophylaxis - child |
77 |
48 |
$0.00 |
| D0330 |
Panoramic radiographic image |
106 |
60 |
$0.00 |
| D0191 |
|
51 |
47 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
80 |
48 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
134 |
84 |
$0.00 |
| 3008F |
|
18 |
15 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
276 |
200 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
49 |
28 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
103 |
58 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
133 |
85 |
$0.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
19 |
18 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
95 |
37 |
$0.00 |
| D1351 |
Sealant - per tooth |
66 |
15 |
$0.00 |
| 91307 |
|
20 |
17 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
15 |
15 |
$0.00 |