| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
11,342 |
9,560 |
$1.21M |
| 99199 |
Unlisted special service, procedure or report |
63,892 |
32,135 |
$490K |
| D1110 |
Prophylaxis - adult |
189 |
169 |
$6K |
| 0012A |
|
48 |
48 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
103 |
100 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
180 |
167 |
$3K |
| 0011A |
|
39 |
39 |
$2K |
| 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 |
132 |
120 |
$2K |
| 82962 |
|
243 |
209 |
$753.25 |
| D0140 |
Limited oral evaluation - problem focused |
20 |
19 |
$720.60 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
301 |
272 |
$206.12 |
| D0230 |
Intraoral - periapical each additional radiographic image |
15 |
14 |
$198.15 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
937 |
823 |
$167.70 |
| 3078F |
|
123 |
110 |
$0.00 |
| 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 |
87 |
83 |
$0.00 |
| 3008F |
|
154 |
143 |
$0.00 |
| 3074F |
|
225 |
208 |
$0.00 |
| 91301 |
|
115 |
108 |
$0.00 |
| 3079F |
|
120 |
115 |
$0.00 |