| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
17,169 |
13,611 |
$1.63M |
| 99199 |
Unlisted special service, procedure or report |
128,410 |
66,199 |
$768K |
| D0230 |
Intraoral - periapical each additional radiographic image |
468 |
215 |
$5K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,563 |
1,415 |
$5K |
| G0071 |
Payment for communication technology-based services for 5 minutes or more of a virtual (non-face-to-face) communication between an rural health clinic (rhc) or federally qualified health center (fqhc) practitioner and rhc or fqhc patient, or 5 minutes or more of remote evaluation of recorded video and/or images by an rhc or fqhc practitioner, occurring in lieu of an office visit; rhc or fqhc only |
445 |
377 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
345 |
319 |
$5K |
| D0330 |
Panoramic radiographic image |
80 |
73 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
77 |
71 |
$3K |
| 0011A |
|
46 |
46 |
$3K |
| D0274 |
Bitewings - four radiographic images |
92 |
86 |
$2K |
| 0012A |
|
37 |
35 |
$2K |
| 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 |
85 |
72 |
$969.60 |
| D0120 |
Periodic oral evaluation - established patient |
30 |
30 |
$769.99 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
812 |
729 |
$753.36 |
| D1110 |
Prophylaxis - adult |
17 |
14 |
$548.62 |
| 93000 |
|
16 |
12 |
$135.82 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
17 |
13 |
$85.20 |
| 3078F |
|
318 |
299 |
$0.00 |
| 3725F |
|
478 |
448 |
$0.00 |
| 3074F |
|
262 |
250 |
$0.00 |
| 91301 |
|
106 |
104 |
$0.00 |
| 3079F |
|
39 |
39 |
$0.00 |
| 36416 |
|
46 |
41 |
$0.00 |