| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
6,426 |
5,772 |
$207K |
| 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 |
514 |
452 |
$553.97 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
36 |
32 |
$67.38 |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
200 |
150 |
$38.90 |
| D0190 |
|
1,892 |
1,821 |
$0.00 |
| D1120 |
Prophylaxis - child |
1,976 |
1,808 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
39 |
36 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
371 |
349 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
113 |
90 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
2,292 |
2,102 |
$0.00 |
| D1330 |
|
2,125 |
1,878 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
550 |
496 |
$0.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
407 |
349 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
218 |
100 |
$0.00 |
| D0603 |
|
46 |
41 |
$0.00 |
| D0240 |
|
54 |
20 |
$0.00 |
| D0601 |
|
43 |
38 |
$0.00 |
| 90688 |
|
12 |
12 |
$0.00 |