| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
7,873 |
7,394 |
$233K |
| 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 |
525 |
456 |
$410.79 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
116 |
104 |
$70.46 |
| D0190 |
|
3,936 |
3,780 |
$0.00 |
| D1120 |
Prophylaxis - child |
1,100 |
1,040 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
182 |
182 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
103 |
99 |
$0.00 |
| D0191 |
|
33 |
33 |
$0.00 |
| D1330 |
|
2,469 |
2,266 |
$0.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
337 |
312 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
1,427 |
1,351 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
151 |
84 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
113 |
107 |
$0.00 |
| D0602 |
|
81 |
68 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
45 |
41 |
$0.00 |
| 82962 |
|
30 |
26 |
$0.00 |
| D0601 |
|
48 |
47 |
$0.00 |