| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
49,431 |
42,234 |
$908K |
| 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 |
800 |
695 |
$1K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
157 |
139 |
$134.62 |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
129 |
114 |
$77.80 |
| D0120 |
Periodic oral evaluation - established patient |
13,050 |
11,902 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
1,240 |
1,135 |
$0.00 |
| D0240 |
|
5,849 |
3,038 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,499 |
2,249 |
$0.00 |
| D1330 |
|
12,577 |
10,649 |
$0.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
922 |
841 |
$0.00 |
| D0602 |
|
1,665 |
1,439 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,037 |
3,292 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,787 |
7,956 |
$0.00 |
| D0601 |
|
567 |
472 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
4,500 |
3,959 |
$0.00 |
| D0603 |
|
1,105 |
966 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
20,570 |
18,817 |
$0.00 |
| D1351 |
Sealant - per tooth |
5,017 |
1,719 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
127 |
119 |
$0.00 |
| D0604 |
|
102 |
97 |
$0.00 |
| D7111 |
|
21 |
14 |
$0.00 |
| 90688 |
|
42 |
42 |
$0.00 |
| 92558 |
|
39 |
38 |
$0.00 |
| 90686 |
|
50 |
49 |
$0.00 |
| D0999 |
Unspecified diagnostic procedure, by report |
131 |
127 |
$0.00 |
| 82962 |
|
19 |
18 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
18 |
14 |
$0.00 |
| D1120 |
Prophylaxis - child |
17,627 |
16,062 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
9,707 |
8,873 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
3,788 |
3,433 |
$0.00 |
| D0190 |
|
7,883 |
7,603 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
428 |
419 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,384 |
2,171 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
4,440 |
4,119 |
$0.00 |
| D1110 |
Prophylaxis - adult |
2,153 |
1,976 |
$0.00 |
| D0330 |
Panoramic radiographic image |
2,847 |
2,656 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
870 |
809 |
$0.00 |
| D1354 |
|
204 |
73 |
$0.00 |
| 90461 |
|
31 |
30 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
26 |
25 |
$0.00 |
| D0270 |
|
25 |
25 |
$0.00 |
| D1203 |
|
14 |
14 |
$0.00 |