| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
31,405 |
24,314 |
$5.04M |
| G0468 |
Federally qualified health center (fqhc) visit, ippe or awv; a fqhc visit that includes an initial preventive physical examination (ippe) or annual wellness visit (awv) and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving an ippe or awv |
5,580 |
4,665 |
$536K |
| D1120 |
Prophylaxis - child |
7,464 |
5,533 |
$288K |
| G0466 |
Federally qualified health center (fqhc) visit, new patient; a medically-necessary, face-to-face encounter (one-on-one) between a new 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 |
2,110 |
1,642 |
$279K |
| D1206 |
Topical application of fluoride varnish |
9,071 |
6,691 |
$208K |
| D0120 |
Periodic oral evaluation - established patient |
7,560 |
5,364 |
$206K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
948 |
675 |
$165K |
| D1110 |
Prophylaxis - adult |
2,968 |
2,170 |
$144K |
| T1015 |
Clinic visit/encounter, all-inclusive |
1,321 |
738 |
$118K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
647 |
431 |
$101K |
| D0274 |
Bitewings - four radiographic images |
2,676 |
1,837 |
$88K |
| D1351 |
Sealant - per tooth |
2,217 |
322 |
$71K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,116 |
824 |
$46K |
| D0272 |
Bitewings - two radiographic images |
882 |
593 |
$21K |
| D0145 |
Oral evaluation for a patient under three years of age |
324 |
241 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
157 |
132 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
628 |
459 |
$9K |
| D0330 |
Panoramic radiographic image |
89 |
68 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
72 |
61 |
$2K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
8,553 |
7,050 |
$2K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,212 |
1,814 |
$607.41 |
| 81002 |
|
4,228 |
3,385 |
$492.27 |
| 99177 |
|
6,159 |
5,159 |
$464.27 |
| G0470 |
Federally qualified health center (fqhc) visit, mental health, established patient; a medically-necessary, face-to-face mental health 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 mental health visit |
156 |
120 |
$441.14 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
2,378 |
1,891 |
$270.93 |
| 82962 |
|
2,103 |
1,621 |
$260.30 |
| 90685 |
|
34 |
33 |
$132.54 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
2,605 |
2,181 |
$83.40 |
| G0071 |
Payment for communication technology-based services for 5 minutes or more of a virtual (non-face-to-face) communication between an rural health clinic (rhc) or federally qualified health center (fqhc) practitioner and rhc or fqhc patient, or 5 minutes or more of remote evaluation of recorded video and/or images by an rhc or fqhc practitioner, occurring in lieu of an office visit; rhc or fqhc only |
243 |
196 |
$79.26 |
| 81025 |
|
312 |
246 |
$37.05 |
| 90633 |
|
397 |
332 |
$22.74 |
| 90688 |
|
52 |
51 |
$22.07 |
| 90686 |
|
637 |
528 |
$17.01 |
| 99441 |
|
66 |
58 |
$14.32 |
| 86580 |
|
55 |
28 |
$11.80 |
| 90710 |
|
96 |
77 |
$8.03 |
| 90670 |
|
788 |
669 |
$1.86 |
| 83655 |
|
291 |
228 |
$0.74 |
| 90648 |
|
372 |
320 |
$0.60 |
| 90734 |
|
83 |
78 |
$0.43 |
| 90698 |
|
169 |
138 |
$0.33 |
| 90715 |
|
65 |
52 |
$0.14 |
| 90681 |
|
157 |
118 |
$0.14 |
| 90723 |
|
144 |
123 |
$0.13 |
| 90651 |
|
21 |
21 |
$0.08 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
4,009 |
2,903 |
$0.00 |
| 90461 |
|
2,265 |
1,543 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
1,236 |
1,065 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
829 |
698 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
1,619 |
1,420 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
58 |
48 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
1,412 |
1,246 |
$0.00 |
| 99173 |
|
262 |
194 |
$0.00 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
85 |
69 |
$0.00 |
| 99401 |
|
302 |
288 |
$0.00 |
| S9470 |
Nutritional counseling, dietitian visit |
641 |
548 |
$0.00 |
| 99442 |
|
175 |
156 |
$0.00 |
| 91300 |
|
15 |
14 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
51 |
37 |
$0.00 |
| D0190 |
|
147 |
127 |
$0.00 |
| 90658 |
|
23 |
23 |
$0.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
15 |
13 |
$0.00 |
| 90707 |
|
18 |
13 |
$0.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
22 |
17 |
$0.00 |
| 99215 |
Prolong outpt/office vis |
16 |
16 |
$0.00 |
| 97802 |
|
2,686 |
2,333 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
807 |
734 |
$0.00 |
| D0603 |
|
4,340 |
3,942 |
$0.00 |
| G0439 |
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit |
125 |
119 |
$0.00 |
| 90716 |
|
33 |
28 |
$0.00 |
| D0602 |
|
1,309 |
1,136 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
25 |
25 |
$0.00 |
| D0601 |
|
499 |
444 |
$0.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
366 |
297 |
$0.00 |
| 0012A |
|
38 |
38 |
$0.00 |
| 90656 |
|
54 |
54 |
$0.00 |
| 1000F |
|
63 |
49 |
$0.00 |
| 99000 |
|
13 |
13 |
$0.00 |
| 0011A |
|
16 |
16 |
$0.00 |
| 91301 |
|
121 |
106 |
$0.00 |