| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
4,649 |
3,913 |
$1.07M |
| D0999 |
Unspecified diagnostic procedure, by report |
1,173 |
1,118 |
$308K |
| 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 |
1,056 |
930 |
$34K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
94 |
70 |
$21K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,001 |
909 |
$14K |
| 90832 |
Psychotherapy, 30 minutes with patient |
61 |
59 |
$5K |
| 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 |
211 |
197 |
$3K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
57 |
52 |
$2K |
| D1110 |
Prophylaxis - adult |
75 |
71 |
$56.00 |
| D1206 |
Topical application of fluoride varnish |
549 |
537 |
$18.00 |
| D0220 |
Intraoral - periapical first radiographic image |
401 |
395 |
$0.00 |
| D1120 |
Prophylaxis - child |
281 |
273 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
116 |
47 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
202 |
196 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
42 |
42 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
490 |
483 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
219 |
213 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
372 |
366 |
$0.00 |
| D0602 |
|
38 |
38 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
21 |
21 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
16 |
16 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
31 |
31 |
$0.00 |
| D1351 |
Sealant - per tooth |
136 |
31 |
$0.00 |
| D0603 |
|
699 |
686 |
$0.00 |
| 90686 |
|
17 |
17 |
$0.00 |