| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
3,938 |
3,414 |
$585K |
| H0031 |
Mental health assessment, by non-physician |
569 |
325 |
$80K |
| 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 |
1,406 |
1,159 |
$23K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
916 |
858 |
$19K |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
384 |
297 |
$16K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
96 |
96 |
$753.68 |
| D1208 |
Topical application of fluoride, excluding varnish |
572 |
571 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
143 |
143 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
27 |
27 |
$0.00 |
| D1120 |
Prophylaxis - child |
363 |
363 |
$0.00 |
| D1110 |
Prophylaxis - adult |
402 |
402 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
55 |
55 |
$0.00 |
| D4341 |
|
101 |
67 |
$0.00 |