| 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 |
13,678 |
9,829 |
$1.89M |
| 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 |
2,129 |
1,234 |
$340K |
| 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 |
1,835 |
1,250 |
$127K |
| 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 |
614 |
462 |
$80K |
| D1110 |
Prophylaxis - adult |
1,461 |
1,139 |
$72K |
| D1120 |
Prophylaxis - child |
1,827 |
1,169 |
$58K |
| D0120 |
Periodic oral evaluation - established patient |
2,021 |
1,353 |
$50K |
| D1206 |
Topical application of fluoride varnish |
2,468 |
1,588 |
$47K |
| D0274 |
Bitewings - four radiographic images |
1,076 |
672 |
$32K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
124 |
86 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
382 |
199 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
85 |
35 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
269 |
212 |
$4K |
| G0469 |
Federally qualified health center (fqhc) visit, mental health, new patient; a medically-necessary, face-to-face mental health 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 mental health visit |
13 |
12 |
$3K |
| D1351 |
Sealant - per tooth |
105 |
17 |
$3K |
| D0272 |
Bitewings - two radiographic images |
56 |
29 |
$999.18 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,350 |
1,830 |
$948.38 |
| D0330 |
Panoramic radiographic image |
21 |
12 |
$818.01 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,177 |
985 |
$589.94 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
2,844 |
1,938 |
$95.22 |
| 90837 |
Psychotherapy, 53 minutes with patient |
441 |
251 |
$79.89 |
| 82962 |
|
795 |
469 |
$61.13 |
| 99177 |
|
1,531 |
953 |
$57.05 |
| 90832 |
Psychotherapy, 30 minutes with patient |
88 |
69 |
$30.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
530 |
350 |
$7.15 |
| 81002 |
|
428 |
237 |
$4.04 |
| 90686 |
|
281 |
196 |
$0.50 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
1,505 |
767 |
$0.00 |
| S9470 |
Nutritional counseling, dietitian visit |
140 |
77 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
32 |
25 |
$0.00 |
| 90461 |
|
493 |
232 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
24 |
24 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
252 |
152 |
$0.00 |
| 99401 |
|
31 |
28 |
$0.00 |
| 81025 |
|
46 |
15 |
$0.00 |
| 99173 |
|
15 |
12 |
$0.00 |
| D0603 |
|
958 |
884 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
171 |
134 |
$0.00 |
| 97802 |
|
554 |
354 |
$0.00 |
| 90688 |
|
42 |
30 |
$0.00 |
| D0602 |
|
33 |
24 |
$0.00 |
| 91301 |
|
33 |
28 |
$0.00 |
| 90834 |
Psychotherapy, 45 minutes with patient |
15 |
13 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
23 |
14 |
$0.00 |
| 0012A |
|
23 |
22 |
$0.00 |