| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
6,498 |
5,375 |
$188K |
| 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 |
526 |
443 |
$33.69 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
108 |
92 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
978 |
808 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
272 |
204 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
132 |
84 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
830 |
687 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
515 |
495 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
378 |
330 |
$0.00 |
| D0603 |
|
76 |
68 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
20 |
13 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
188 |
164 |
$0.00 |
| G0439 |
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit |
13 |
12 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
71 |
40 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
13 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
533 |
439 |
$0.00 |
| D1110 |
Prophylaxis - adult |
313 |
258 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
1,761 |
1,534 |
$0.00 |
| D1120 |
Prophylaxis - child |
159 |
132 |
$0.00 |
| D0190 |
|
224 |
224 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
57 |
39 |
$0.00 |