| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
1,912 |
1,736 |
$138K |
| 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 |
1,017 |
895 |
$579.89 |
| D0190 |
|
295 |
295 |
$0.00 |
| D1120 |
Prophylaxis - child |
175 |
175 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
135 |
135 |
$0.00 |
| 90662 |
|
13 |
13 |
$0.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
303 |
271 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
583 |
522 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
398 |
397 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
27 |
27 |
$0.00 |
| 91301 |
|
43 |
42 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
26 |
26 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
14 |
14 |
$0.00 |
| 0012A |
|
23 |
21 |
$0.00 |