| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
4,006 |
2,996 |
$191K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
368 |
282 |
$23K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
309 |
229 |
$9K |
| 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 |
1,497 |
698 |
$7K |
| 99215 |
Prolong outpt/office vis |
72 |
43 |
$4K |
| 90686 |
|
147 |
145 |
$3K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
90 |
87 |
$2K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
12 |
12 |
$1K |
| D1351 |
Sealant - per tooth |
113 |
28 |
$955.80 |
| D1206 |
Topical application of fluoride varnish |
52 |
52 |
$676.80 |
| D0120 |
Periodic oral evaluation - established patient |
26 |
26 |
$676.78 |
| D0191 |
|
64 |
64 |
$416.32 |
| D1208 |
Topical application of fluoride, excluding varnish |
14 |
13 |
$208.00 |
| 36415 |
Collection of venous blood by venipuncture |
17 |
16 |
$33.60 |
| 81002 |
|
14 |
12 |
$31.84 |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
16 |
12 |
$23.56 |
| 1000F |
|
31 |
29 |
$0.02 |
| D1330 |
|
24 |
24 |
$0.00 |
| D0601 |
|
34 |
34 |
$0.00 |