| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
18,883 |
17,595 |
$3.47M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
4,256 |
4,095 |
$33K |
| D7140 |
Extraction, erupted tooth or exposed root |
113 |
56 |
$7K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
573 |
553 |
$3K |
| 0064A |
|
39 |
39 |
$1K |
| D2140 |
|
19 |
12 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$731.76 |
| 0004A |
|
13 |
13 |
$520.00 |
| 0012A |
|
12 |
12 |
$480.00 |
| 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 |
13 |
13 |
$419.91 |
| 36415 |
Collection of venous blood by venipuncture |
110 |
109 |
$11.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
403 |
394 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
157 |
157 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
144 |
144 |
$0.00 |
| D0330 |
Panoramic radiographic image |
120 |
120 |
$0.00 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
275 |
270 |
$0.00 |
| D1110 |
Prophylaxis - adult |
54 |
54 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
12 |
12 |
$0.00 |
| D0190 |
|
14 |
14 |
$0.00 |