| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
34,095 |
20,942 |
$2.92M |
| 99199 |
Unlisted special service, procedure or report |
71,945 |
41,150 |
$358K |
| D0140 |
Limited oral evaluation - problem focused |
998 |
783 |
$27K |
| D7140 |
Extraction, erupted tooth or exposed root |
278 |
117 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,119 |
777 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
232 |
198 |
$8K |
| D0330 |
Panoramic radiographic image |
142 |
116 |
$6K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
1,306 |
991 |
$4K |
| 36415 |
Collection of venous blood by venipuncture |
3,195 |
2,503 |
$4K |
| D0274 |
Bitewings - four radiographic images |
153 |
125 |
$4K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
855 |
668 |
$3K |
| G0071 |
Payment for communication technology-based services for 5 minutes or more of a virtual (non-face-to-face) communication between an rural health clinic (rhc) or federally qualified health center (fqhc) practitioner and rhc or fqhc patient, or 5 minutes or more of remote evaluation of recorded video and/or images by an rhc or fqhc practitioner, occurring in lieu of an office visit; rhc or fqhc only |
644 |
337 |
$2K |
| 99454 |
|
67 |
65 |
$2K |
| 82962 |
|
748 |
583 |
$1K |
| D1110 |
Prophylaxis - adult |
31 |
31 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
42 |
41 |
$994.31 |
| D1120 |
Prophylaxis - child |
15 |
13 |
$336.31 |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$183.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
39 |
35 |
$42.36 |
| 20610 |
|
53 |
44 |
$0.00 |
| 90658 |
|
14 |
14 |
$0.00 |
| T1017 |
Targeted case management, each 15 minutes |
83 |
63 |
$0.00 |
| 99423 |
|
12 |
12 |
$0.00 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
13 |
13 |
$0.00 |