| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
57,992 |
38,384 |
$13.29M |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
419 |
175 |
$5K |
| 99442 |
|
5,016 |
4,686 |
$3K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
5,128 |
4,813 |
$1K |
| 0012A |
|
52 |
52 |
$1K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
210 |
203 |
$1K |
| 0031A |
|
41 |
40 |
$960.00 |
| 0011A |
|
52 |
52 |
$760.00 |
| 99441 |
|
1,929 |
1,840 |
$492.17 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
2,191 |
2,043 |
$178.00 |
| 90686 |
|
45 |
45 |
$21.52 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
54 |
54 |
$18.05 |
| 3008F |
|
6,027 |
5,649 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
450 |
447 |
$0.00 |
| 91301 |
|
65 |
65 |
$0.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
64 |
60 |
$0.00 |
| 99443 |
|
44 |
38 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
48 |
46 |
$0.00 |
| D0603 |
|
28 |
28 |
$0.00 |
| 91303 |
|
26 |
26 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
17 |
13 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
12 |
12 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
158 |
155 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
145 |
142 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
15 |
15 |
$0.00 |
| D1110 |
Prophylaxis - adult |
371 |
370 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
160 |
159 |
$0.00 |
| 90461 |
|
25 |
25 |
$0.00 |
| 81025 |
|
14 |
14 |
$0.00 |