| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
913 |
819 |
$220K |
| D0999 |
Unspecified diagnostic procedure, by report |
486 |
454 |
$126K |
| 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 |
411 |
370 |
$13K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
225 |
212 |
$2K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
14 |
12 |
$243.72 |
| D1120 |
Prophylaxis - child |
68 |
66 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
64 |
61 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
45 |
45 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
109 |
104 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
120 |
117 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
63 |
58 |
$0.00 |
| D0601 |
|
31 |
31 |
$0.00 |
| D0603 |
|
188 |
185 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
18 |
17 |
$0.00 |
| D0602 |
|
13 |
13 |
$0.00 |