| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
3,157 |
2,615 |
$21K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,566 |
2,140 |
$16K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
207 |
192 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
181 |
180 |
$4K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
25 |
25 |
$2K |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
148 |
94 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
34 |
34 |
$1K |
| D1206 |
Topical application of fluoride varnish |
200 |
199 |
$1K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
62 |
62 |
$1K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
133 |
131 |
$1K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
16 |
15 |
$1K |
| 99188 |
|
61 |
61 |
$1K |
| D1120 |
Prophylaxis - child |
79 |
79 |
$911.47 |
| D1110 |
Prophylaxis - adult |
31 |
31 |
$751.33 |
| D0274 |
Bitewings - four radiographic images |
122 |
122 |
$704.25 |
| D1330 |
|
461 |
458 |
$509.84 |
| D0220 |
Intraoral - periapical first radiographic image |
140 |
136 |
$227.25 |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$208.26 |
| D0230 |
Intraoral - periapical each additional radiographic image |
36 |
28 |
$81.95 |
| D0140 |
Limited oral evaluation - problem focused |
15 |
15 |
$47.90 |
| 90686 |
|
25 |
24 |
$0.00 |