| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
23,988 |
19,957 |
$2.15M |
| 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 |
5,065 |
4,755 |
$247K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
11,614 |
9,559 |
$215K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
5,722 |
4,408 |
$50K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,361 |
1,164 |
$36K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
951 |
821 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
133 |
97 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
81 |
63 |
$4K |
| D0330 |
Panoramic radiographic image |
84 |
62 |
$3K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
376 |
361 |
$3K |
| 0012A |
|
185 |
176 |
$2K |
| D1110 |
Prophylaxis - adult |
47 |
38 |
$2K |
| 0011A |
|
190 |
166 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
14 |
12 |
$2K |
| D0274 |
Bitewings - four radiographic images |
35 |
28 |
$866.00 |
| 0064A |
|
125 |
97 |
$600.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
14 |
12 |
$275.00 |
| 0002A |
|
39 |
34 |
$230.00 |
| 0001A |
|
32 |
32 |
$225.00 |
| 0071A |
|
20 |
15 |
$200.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
120 |
117 |
$15.56 |
| 36415 |
Collection of venous blood by venipuncture |
113 |
55 |
$4.78 |
| 99173 |
|
389 |
376 |
$2.60 |
| 99406 |
|
74 |
62 |
$0.00 |
| 99383 |
|
27 |
27 |
$0.00 |
| V5008 |
Hearing screening |
137 |
130 |
$0.00 |
| 99384 |
|
67 |
53 |
$0.00 |
| 91301 |
|
46 |
43 |
$0.00 |
| 99385 |
|
28 |
28 |
$0.00 |
| 99000 |
|
12 |
12 |
$0.00 |
| 0134A |
|
26 |
26 |
$0.00 |
| 99386 |
|
26 |
24 |
$0.00 |
| 99402 |
|
24 |
12 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
103 |
102 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
44 |
44 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
58 |
57 |
$0.00 |