| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
9,645 |
7,849 |
$2.27M |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,094 |
1,881 |
$934.70 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
73 |
69 |
$587.73 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,082 |
1,888 |
$521.50 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
131 |
121 |
$454.86 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
322 |
304 |
$126.20 |
| 96127 |
|
85 |
77 |
$40.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
638 |
613 |
$37.75 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
26 |
26 |
$34.30 |
| 90686 |
|
330 |
320 |
$21.88 |
| 90688 |
|
14 |
14 |
$16.94 |
| 1036F |
|
963 |
850 |
$0.00 |
| 90834 |
Psychotherapy, 45 minutes with patient |
181 |
139 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
33 |
25 |
$0.00 |
| 1220F |
|
881 |
810 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
512 |
403 |
$0.00 |
| 1125F |
|
414 |
372 |
$0.00 |
| 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 |
28 |
26 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
184 |
104 |
$0.00 |
| 1157F |
|
18 |
16 |
$0.00 |
| 1126F |
|
35 |
32 |
$0.00 |
| 0001A |
|
13 |
13 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
14 |
12 |
$0.00 |
| 1158F |
|
445 |
408 |
$0.00 |
| 81003 |
|
227 |
214 |
$0.00 |
| 90715 |
|
135 |
129 |
$0.00 |
| 1159F |
|
863 |
761 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
64 |
64 |
$0.00 |
| 90837 |
Psychotherapy, 53 minutes with patient |
39 |
28 |
$0.00 |
| 90791 |
Psychiatric diagnostic evaluation |
15 |
15 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
43 |
40 |
$0.00 |
| 91300 |
|
14 |
13 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
480 |
382 |
$0.00 |