| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
4,527 |
3,923 |
$146K |
| 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 |
354 |
301 |
$134.76 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
217 |
175 |
$92.65 |
| D0220 |
Intraoral - periapical first radiographic image |
551 |
492 |
$0.00 |
| D1120 |
Prophylaxis - child |
185 |
166 |
$0.00 |
| D0190 |
|
978 |
974 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
200 |
173 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
821 |
793 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
15 |
13 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
78 |
67 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
119 |
98 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
13 |
12 |
$0.00 |