| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 59426 |
|
1,386 |
1,385 |
$1.34M |
| 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 |
10,525 |
9,568 |
$795K |
| D1110 |
Prophylaxis - adult |
2,124 |
2,120 |
$225K |
| G0470 |
Federally qualified health center (fqhc) visit, mental health, established patient; a medically-necessary, face-to-face mental health 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 mental health visit |
988 |
807 |
$67K |
| D1120 |
Prophylaxis - child |
1,465 |
1,465 |
$63K |
| D0191 |
|
3,841 |
3,821 |
$60K |
| D1206 |
Topical application of fluoride varnish |
1,756 |
1,749 |
$46K |
| 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 |
594 |
594 |
$41K |
| 59430 |
|
1,275 |
1,267 |
$24K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
5,310 |
4,991 |
$20K |
| 59425 |
|
26 |
26 |
$13K |
| G0466 |
Federally qualified health center (fqhc) visit, new patient; a medically-necessary, face-to-face encounter (one-on-one) between a new 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 |
153 |
153 |
$11K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
203 |
203 |
$9K |
| D1351 |
Sealant - per tooth |
292 |
40 |
$7K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
612 |
598 |
$4K |
| 81025 |
|
4,304 |
4,182 |
$3K |
| 90834 |
Psychotherapy, 45 minutes with patient |
204 |
167 |
$2K |
| 90832 |
Psychotherapy, 30 minutes with patient |
162 |
146 |
$1K |
| H0031 |
Mental health assessment, by non-physician |
98 |
98 |
$729.68 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
121 |
121 |
$725.30 |
| 90715 |
|
36 |
36 |
$724.80 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
389 |
385 |
$503.39 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
60 |
56 |
$499.10 |
| 90686 |
|
69 |
69 |
$217.59 |
| 59025 |
Fetal non-stress test |
54 |
36 |
$94.56 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
28 |
28 |
$60.02 |
| 81002 |
|
27 |
25 |
$2.20 |
| D1330 |
|
3,344 |
3,309 |
$0.00 |