| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
3,624 |
2,560 |
$205K |
| D0140 |
Limited oral evaluation - problem focused |
692 |
607 |
$77K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
477 |
288 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
356 |
297 |
$26K |
| D1120 |
Prophylaxis - child |
676 |
580 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
52 |
52 |
$5K |
| 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 |
517 |
408 |
$2K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
16 |
16 |
$2K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
35 |
27 |
$2K |
| D1206 |
Topical application of fluoride varnish |
790 |
667 |
$1K |
| 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 |
19 |
12 |
$31.92 |
| 3078F |
|
277 |
214 |
$0.00 |
| 3725F |
|
328 |
232 |
$0.00 |
| 1160F |
|
504 |
362 |
$0.00 |
| 1159F |
|
504 |
362 |
$0.00 |
| 83655 |
|
56 |
41 |
$0.00 |
| 99173 |
|
145 |
128 |
$0.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
125 |
74 |
$0.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
16 |
14 |
$0.00 |
| 3008F |
|
555 |
379 |
$0.00 |
| 3074F |
|
275 |
218 |
$0.00 |
| 1126F |
|
352 |
269 |
$0.00 |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
58 |
48 |
$0.00 |
| D1330 |
|
26 |
13 |
$0.00 |
| 92551 |
|
41 |
29 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
14 |
13 |
$0.00 |
| D0603 |
|
46 |
46 |
$0.00 |
| 85018 |
|
61 |
45 |
$0.00 |