| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
22,155 |
16,353 |
$3.88M |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
12,435 |
8,904 |
$30K |
| D7140 |
Extraction, erupted tooth or exposed root |
133 |
47 |
$10K |
| D1110 |
Prophylaxis - adult |
163 |
127 |
$6K |
| 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 |
255 |
207 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
74 |
63 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
130 |
98 |
$2K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
4,136 |
3,368 |
$2K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
175 |
168 |
$927.04 |
| D0220 |
Intraoral - periapical first radiographic image |
65 |
53 |
$918.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
39 |
38 |
$454.74 |
| 0124A |
|
21 |
21 |
$384.00 |
| 90480 |
|
43 |
18 |
$320.00 |
| 80305 |
|
724 |
373 |
$77.32 |
| 90686 |
|
430 |
410 |
$73.84 |
| 90853 |
Group psychotherapy (other than of a multiple-family group) |
62 |
38 |
$4.08 |
| D1330 |
|
251 |
202 |
$0.03 |
| 91312 |
|
20 |
20 |
$0.00 |
| 99215 |
Prolong outpt/office vis |
15 |
14 |
$0.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
33 |
30 |
$0.00 |
| 91320 |
|
43 |
18 |
$0.00 |
| 90834 |
Psychotherapy, 45 minutes with patient |
104 |
53 |
$0.00 |
| 36416 |
|
13 |
12 |
$0.00 |