| T1040 | Medicaid certified community behavioral health clinic services, per diem | 81 | 170 | 950 | $200 | $1.8M |
| T1015 | Clinic visit/encounter, all-inclusive | 38 | 550 | 90 | $140 | $1.5M |
| G0470 | Federally qualified health center (fqhc) visit, mental health, established patient; a medically-necessary, face-to-face mental health encounter (one-on-one) between an established patient and a fqhc… | 44 | 80 | 1,720 | $150 | $800.5K |
| 99211 | An established patient presents for an office or other outpatient visit that may not require the presence of a physician or other qualified healthcare professional. | 89 | 410 | 140 | $110 | $742.2K |
| D9450 | N/A | 32 | 150 | 2,450 | $30 | $506.8K |
| 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… | 52 | 110 | 3,490 | $40 | $309.9K |
| 99212 | The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,… | 69 | 950 | 90 | $100 | $212.9K |
| 99214 | The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the… | 439 | 5,040 | 200 | $70 | $209.5K |
| 99213 | The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the… | 213 | 5,300 | 230 | $60 | $164.5K |
| D7210 | Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation; includes related cutting of gingiva and bone, removal of tooth structure, minor smoothing of… | 246 | 370 | 300 | $130 | $138.7K |