| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
1,174 |
1,102 |
$358K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,059 |
1,005 |
$32K |
| 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 |
814 |
732 |
$28K |
| D0999 |
Unspecified diagnostic procedure, by report |
115 |
106 |
$27K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
12 |
12 |
$4K |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
131 |
114 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
17 |
17 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
177 |
172 |
$0.00 |
| D0602 |
|
13 |
13 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
16 |
16 |
$0.00 |
| D0601 |
|
18 |
18 |
$0.00 |
| D1120 |
Prophylaxis - child |
16 |
16 |
$0.00 |