| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
19,947 |
12,673 |
$2.33M |
| D0120 |
Periodic oral evaluation - established patient |
230 |
220 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
73 |
27 |
$2K |
| D0330 |
Panoramic radiographic image |
79 |
76 |
$2K |
| D0274 |
Bitewings - four radiographic images |
30 |
25 |
$760.00 |
| D0140 |
Limited oral evaluation - problem focused |
50 |
37 |
$616.06 |
| D0220 |
Intraoral - periapical first radiographic image |
33 |
24 |
$123.04 |
| 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 |
8,231 |
3,564 |
$114.09 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
3,598 |
2,586 |
$0.00 |
| 81002 |
|
469 |
418 |
$0.00 |
| D2999 |
|
454 |
389 |
$0.00 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
84 |
66 |
$0.00 |
| 90832 |
Psychotherapy, 30 minutes with patient |
263 |
220 |
$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 |
61 |
31 |
$0.00 |
| D1110 |
Prophylaxis - adult |
12 |
12 |
$0.00 |
| 11721 |
|
17 |
13 |
$0.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
747 |
682 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
4,879 |
3,592 |
$0.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
14,728 |
9,729 |
$0.00 |
| D0999 |
Unspecified diagnostic procedure, by report |
935 |
849 |
$0.00 |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
360 |
172 |
$0.00 |
| 82962 |
|
2,741 |
1,861 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
697 |
661 |
$0.00 |
| 90688 |
|
767 |
613 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
267 |
150 |
$0.00 |
| 90686 |
|
82 |
61 |
$0.00 |
| D1330 |
|
12 |
12 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
12 |
12 |
$0.00 |