| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
4,017 |
3,359 |
$268K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,228 |
2,025 |
$107K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
220 |
202 |
$7K |
| T1015 |
Clinic visit/encounter, all-inclusive |
47 |
37 |
$6K |
| 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 |
23 |
13 |
$4K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
400 |
393 |
$4K |
| D1351 |
Sealant - per tooth |
174 |
15 |
$3K |
| T1017 |
Targeted case management, each 15 minutes |
78 |
58 |
$2K |
| 80061 |
Lipid panel |
59 |
58 |
$2K |
| D1120 |
Prophylaxis - child |
42 |
14 |
$2K |
| D0274 |
Bitewings - four radiographic images |
66 |
22 |
$2K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
85 |
82 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
51 |
17 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
60 |
20 |
$1K |
| 80048 |
Basic metabolic panel (calcium, ionized) |
49 |
47 |
$903.84 |
| 99443 |
|
15 |
14 |
$635.25 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
35 |
35 |
$277.44 |
| 99406 |
|
12 |
12 |
$95.00 |