| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
27,558 |
20,672 |
$4.09M |
| 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 |
2,665 |
2,208 |
$87K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
5,384 |
4,545 |
$9K |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
125 |
106 |
$8K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
9,748 |
8,050 |
$4K |
| D1206 |
Topical application of fluoride varnish |
3,370 |
3,232 |
$2K |
| D1120 |
Prophylaxis - child |
2,177 |
2,102 |
$2K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
419 |
401 |
$1K |
| 36415 |
Collection of venous blood by venipuncture |
2,501 |
2,293 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
377 |
258 |
$785.20 |
| D0140 |
Limited oral evaluation - problem focused |
1,225 |
1,154 |
$725.73 |
| G0470 |
Federally qualified health center (fqhc) visit, mental health, established patient; a medically-necessary, face-to-face mental health 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 mental health visit |
21 |
12 |
$646.94 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
191 |
165 |
$599.73 |
| 80305 |
|
102 |
69 |
$535.12 |
| D0330 |
Panoramic radiographic image |
545 |
531 |
$533.20 |
| 0031A |
|
14 |
14 |
$484.77 |
| 90837 |
Psychotherapy, 53 minutes with patient |
1,545 |
1,007 |
$460.42 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
764 |
704 |
$409.05 |
| 36416 |
|
756 |
693 |
$359.93 |
| 82962 |
|
438 |
418 |
$349.96 |
| 90834 |
Psychotherapy, 45 minutes with patient |
786 |
601 |
$314.78 |
| D0274 |
Bitewings - four radiographic images |
956 |
933 |
$296.55 |
| D1351 |
Sealant - per tooth |
150 |
55 |
$263.66 |
| D1110 |
Prophylaxis - adult |
2,056 |
1,954 |
$240.15 |
| 99215 |
Prolong outpt/office vis |
135 |
95 |
$230.21 |
| D0220 |
Intraoral - periapical first radiographic image |
976 |
917 |
$188.68 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
129 |
127 |
$162.28 |
| D0120 |
Periodic oral evaluation - established patient |
1,154 |
1,115 |
$71.74 |
| 81002 |
|
48 |
47 |
$69.98 |
| G0008 |
Administration of influenza virus vaccine |
86 |
82 |
$55.19 |
| 81003 |
|
18 |
18 |
$33.80 |
| 90688 |
|
255 |
246 |
$16.36 |
| D0272 |
Bitewings - two radiographic images |
234 |
231 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
535 |
516 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
120 |
88 |
$0.00 |
| D0603 |
|
296 |
286 |
$0.00 |
| 90673 |
|
14 |
14 |
$0.00 |
| 90686 |
|
12 |
12 |
$0.00 |
| G0439 |
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit |
15 |
15 |
$0.00 |
| D0601 |
|
28 |
28 |
$0.00 |
| D0602 |
|
40 |
40 |
$0.00 |
| 90656 |
|
22 |
22 |
$0.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
29 |
25 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
36 |
28 |
$0.00 |
| 90832 |
Psychotherapy, 30 minutes with patient |
32 |
29 |
$0.00 |
| D1354 |
|
13 |
12 |
$0.00 |