| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
47,432 |
44,449 |
$12.48M |
| 0124A |
|
71 |
71 |
$3K |
| 0054A |
|
74 |
73 |
$2K |
| 0064A |
|
48 |
48 |
$2K |
| 0004A |
|
20 |
20 |
$680.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
9,617 |
9,253 |
$604.34 |
| 0134A |
|
13 |
13 |
$440.00 |
| 0071A |
|
13 |
13 |
$364.70 |
| 0001A |
|
27 |
27 |
$341.64 |
| 90662 |
|
18 |
18 |
$309.92 |
| 90686 |
|
2,608 |
2,601 |
$97.19 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,914 |
1,874 |
$54.42 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,462 |
1,409 |
$26.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,238 |
1,222 |
$20.00 |
| 81025 |
|
1,109 |
1,034 |
$4.00 |
| 97802 |
|
1,024 |
927 |
$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 |
700 |
642 |
$0.00 |
| D1330 |
|
203 |
203 |
$0.00 |
| 92551 |
|
1,661 |
1,604 |
$0.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
14 |
14 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
135 |
135 |
$0.00 |
| 90716 |
|
14 |
12 |
$0.00 |
| 3008F |
|
696 |
588 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
29 |
28 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
39 |
39 |
$0.00 |
| 90677 |
|
42 |
40 |
$0.00 |
| 91301 |
|
27 |
27 |
$0.00 |
| 0012A |
|
101 |
101 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
31 |
31 |
$0.00 |
| 0011A |
|
30 |
30 |
$0.00 |
| 90656 |
|
262 |
262 |
$0.00 |
| 1111F |
|
12 |
12 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
14 |
14 |
$0.00 |
| 90651 |
|
12 |
12 |
$0.00 |
| 0031A |
|
19 |
19 |
$0.00 |
| 1160F |
|
30 |
29 |
$0.00 |
| 90461 |
|
1,207 |
1,152 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
5,056 |
4,926 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
387 |
364 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
980 |
939 |
$0.00 |
| 99173 |
|
1,975 |
1,902 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
230 |
221 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
243 |
228 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
754 |
721 |
$0.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
13 |
12 |
$0.00 |
| D1110 |
Prophylaxis - adult |
117 |
117 |
$0.00 |
| 90670 |
|
14 |
14 |
$0.00 |
| 1159F |
|
30 |
29 |
$0.00 |
| 90648 |
|
56 |
54 |
$0.00 |
| D1120 |
Prophylaxis - child |
13 |
13 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
52 |
51 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
16 |
16 |
$0.00 |
| 90633 |
|
15 |
13 |
$0.00 |