| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
26,537 |
23,152 |
$5.26M |
| 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 |
1,467 |
1,305 |
$32K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
7,933 |
7,603 |
$24K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
8,323 |
7,589 |
$17K |
| 90837 |
Psychotherapy, 53 minutes with patient |
94 |
71 |
$10K |
| 0012A |
|
19 |
19 |
$760.00 |
| 0011A |
|
22 |
22 |
$603.28 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
26 |
26 |
$84.05 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
64 |
64 |
$8.52 |
| D1120 |
Prophylaxis - child |
269 |
269 |
$0.00 |
| D1110 |
Prophylaxis - adult |
128 |
128 |
$0.00 |
| D0190 |
|
114 |
114 |
$0.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
62 |
62 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
29 |
29 |
$0.00 |
| 99215 |
Prolong outpt/office vis |
16 |
16 |
$0.00 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
971 |
969 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
342 |
342 |
$0.00 |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
67 |
65 |
$0.00 |
| 87428 |
|
55 |
55 |
$0.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
61 |
61 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$0.00 |
| D1351 |
Sealant - per tooth |
57 |
19 |
$0.00 |