| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
4,252 |
3,059 |
$473K |
| 99199 |
Unlisted special service, procedure or report |
15,341 |
9,752 |
$87K |
| D0140 |
Limited oral evaluation - problem focused |
1,126 |
1,095 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
1,267 |
1,228 |
$18K |
| D1110 |
Prophylaxis - adult |
354 |
350 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
301 |
300 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
106 |
99 |
$4K |
| 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 |
329 |
226 |
$4K |
| D0330 |
Panoramic radiographic image |
58 |
58 |
$3K |
| D0274 |
Bitewings - four radiographic images |
99 |
97 |
$3K |
| G2023 |
Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
142 |
92 |
$2K |
| 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 |
70 |
51 |
$1K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
157 |
108 |
$1K |
| 36415 |
Collection of venous blood by venipuncture |
525 |
355 |
$763.77 |
| D0230 |
Intraoral - periapical each additional radiographic image |
54 |
28 |
$614.63 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
66 |
45 |
$419.52 |
| 90756 |
|
62 |
38 |
$337.12 |
| 90674 |
|
17 |
16 |
$57.24 |