| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
9,689 |
7,557 |
$1.85M |
| D0120 |
Periodic oral evaluation - established patient |
1,927 |
1,540 |
$284K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
475 |
451 |
$32.58 |
| 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 |
534 |
468 |
$20.92 |
| D0140 |
Limited oral evaluation - problem focused |
400 |
384 |
$0.00 |
| 81000 |
|
467 |
340 |
$0.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
3,047 |
2,685 |
$0.00 |
| 90834 |
Psychotherapy, 45 minutes with patient |
791 |
489 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
195 |
193 |
$0.00 |
| 90686 |
|
13 |
13 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
38 |
38 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
36 |
29 |
$0.00 |
| 90674 |
|
12 |
12 |
$0.00 |
| 90651 |
|
14 |
14 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
748 |
690 |
$0.00 |
| 92552 |
|
286 |
286 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
670 |
644 |
$0.00 |
| 81025 |
|
135 |
133 |
$0.00 |
| 59425 |
|
213 |
157 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
170 |
162 |
$0.00 |
| 99173 |
|
305 |
305 |
$0.00 |
| D1120 |
Prophylaxis - child |
61 |
61 |
$0.00 |
| 90832 |
Psychotherapy, 30 minutes with patient |
355 |
252 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
68 |
68 |
$0.00 |
| D1110 |
Prophylaxis - adult |
17 |
16 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
35 |
35 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
74 |
74 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
24 |
24 |
$0.00 |
| 90710 |
|
15 |
15 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
16 |
16 |
$0.00 |
| 90837 |
Psychotherapy, 53 minutes with patient |
23 |
13 |
$0.00 |