| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9450 |
|
3,896 |
3,055 |
$236K |
| 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 |
6,391 |
5,592 |
$196K |
| T1015 |
Clinic visit/encounter, all-inclusive |
461 |
407 |
$58K |
| D1110 |
Prophylaxis - adult |
890 |
714 |
$38K |
| D0210 |
Intraoral - complete series of radiographic images |
281 |
256 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
427 |
382 |
$17K |
| D1120 |
Prophylaxis - child |
335 |
318 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
468 |
400 |
$16K |
| D1206 |
Topical application of fluoride varnish |
505 |
478 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
574 |
501 |
$12K |
| D0274 |
Bitewings - four radiographic images |
279 |
244 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
108 |
85 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
566 |
451 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
62 |
42 |
$4K |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
113 |
106 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
34 |
12 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
92 |
49 |
$886.00 |
| D9110 |
|
17 |
15 |
$681.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
4,058 |
3,785 |
$0.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,250 |
1,154 |
$0.00 |
| G0439 |
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit |
37 |
37 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
22 |
22 |
$0.00 |
| G0468 |
Federally qualified health center (fqhc) visit, ippe or awv; a fqhc visit that includes an initial preventive physical examination (ippe) or annual wellness visit (awv) and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving an ippe or awv |
51 |
51 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
61 |
51 |
$0.00 |
| 99215 |
Prolong outpt/office vis |
32 |
32 |
$0.00 |