| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
35,509 |
30,062 |
$4.87M |
| 00003 |
Internal/system code - not a standard HCPCS code |
1,398 |
1,039 |
$216K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
12,319 |
6,915 |
$122K |
| 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 |
1,059 |
902 |
$103K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
11,526 |
6,970 |
$84K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,377 |
1,497 |
$36K |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
326 |
305 |
$4K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
163 |
106 |
$4K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
89 |
59 |
$2K |
| D1206 |
Topical application of fluoride varnish |
2,108 |
2,037 |
$684.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,617 |
1,480 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
239 |
227 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
2,650 |
2,642 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,938 |
1,928 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,616 |
2,581 |
$0.00 |
| D5120 |
|
18 |
12 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
1,115 |
1,094 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
28 |
24 |
$0.00 |
| D2330 |
|
58 |
58 |
$0.00 |
| D5212 |
|
22 |
14 |
$0.00 |
| D2331 |
|
88 |
80 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$0.00 |
| D1351 |
Sealant - per tooth |
14 |
14 |
$0.00 |
| D9430 |
|
1,510 |
1,479 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
3,694 |
3,667 |
$0.00 |
| D4341 |
|
505 |
363 |
$0.00 |
| D1120 |
Prophylaxis - child |
1,754 |
1,746 |
$0.00 |
| D0270 |
|
620 |
609 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
2,476 |
2,461 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,366 |
1,247 |
$0.00 |
| D1110 |
Prophylaxis - adult |
937 |
920 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
108 |
108 |
$0.00 |
| D5110 |
|
103 |
78 |
$0.00 |
| D4910 |
|
99 |
97 |
$0.00 |
| G0511 |
Rural health clinic or federally qualified health center (rhc or fqhc) only, general care management, 20 minutes or more of clinical staff time for chronic care management services or behavioral health integration services directed by an rhc or fqhc practitioner (physician, np, pa, or cnm), per calendar month |
88 |
88 |
$0.00 |