| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
5,237 |
3,993 |
$1.04M |
| D0120 |
Periodic oral evaluation - established patient |
473 |
401 |
$74K |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
15 |
12 |
$276.15 |
| 81000 |
|
236 |
183 |
$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 |
290 |
263 |
$0.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,005 |
911 |
$0.00 |
| 90834 |
Psychotherapy, 45 minutes with patient |
1,165 |
730 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
199 |
184 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$0.00 |
| 90686 |
|
14 |
14 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
12 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
51 |
50 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
31 |
24 |
$0.00 |
| 90832 |
Psychotherapy, 30 minutes with patient |
590 |
287 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
65 |
63 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
67 |
67 |
$0.00 |
| 92552 |
|
29 |
29 |
$0.00 |
| 81025 |
|
28 |
26 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
12 |
12 |
$0.00 |
| 99173 |
|
29 |
29 |
$0.00 |
| 90791 |
Psychiatric diagnostic evaluation |
21 |
21 |
$0.00 |
| 90837 |
Psychotherapy, 53 minutes with patient |
24 |
18 |
$0.00 |