| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
4,821 |
4,452 |
$180K |
| 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 |
516 |
404 |
$578.61 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
14 |
12 |
$33.69 |
| D1330 |
|
1,397 |
1,260 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
1,599 |
1,473 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
359 |
340 |
$0.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
443 |
358 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
66 |
54 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
157 |
93 |
$0.00 |
| D0602 |
|
172 |
144 |
$0.00 |
| D0601 |
|
15 |
15 |
$0.00 |
| D0603 |
|
12 |
12 |
$0.00 |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
20 |
13 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
365 |
328 |
$0.00 |
| D1120 |
Prophylaxis - child |
1,181 |
1,085 |
$0.00 |
| D0190 |
|
767 |
750 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
124 |
108 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
28 |
26 |
$0.00 |