| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
49,938 |
38,269 |
$7.00M |
| T1040 |
Medicaid certified community behavioral health clinic services, per diem |
985 |
686 |
$66K |
| D0999 |
Unspecified diagnostic procedure, by report |
279 |
266 |
$41K |
| 90651 |
|
3,087 |
2,597 |
$8K |
| 90734 |
|
2,203 |
1,847 |
$5K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
7,200 |
5,507 |
$2K |
| 90670 |
|
5,691 |
4,343 |
$1K |
| 90710 |
|
1,141 |
958 |
$1K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
3,935 |
3,220 |
$1K |
| 90633 |
|
3,845 |
3,062 |
$858.35 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
11,494 |
9,411 |
$855.34 |
| 90686 |
|
6,567 |
5,633 |
$811.43 |
| 90698 |
|
3,017 |
2,209 |
$736.02 |
| 90620 |
|
1,523 |
1,363 |
$715.00 |
| 90680 |
|
1,428 |
1,077 |
$518.05 |
| 90715 |
|
1,509 |
1,241 |
$410.59 |
| 90716 |
|
1,473 |
1,152 |
$371.25 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
1,260 |
1,201 |
$298.15 |
| 90696 |
|
911 |
770 |
$296.19 |
| 90744 |
|
1,865 |
1,370 |
$241.80 |
| 90707 |
|
1,299 |
1,056 |
$219.16 |
| 96127 |
|
945 |
934 |
$102.20 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
7,223 |
6,124 |
$98.40 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
216 |
204 |
$62.80 |
| 90685 |
|
156 |
86 |
$51.87 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
221 |
212 |
$46.95 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
479 |
469 |
$42.50 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
2,931 |
2,317 |
$32.15 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
2,282 |
1,975 |
$32.15 |
| 90832 |
Psychotherapy, 30 minutes with patient |
3,548 |
2,221 |
$29.48 |
| 81025 |
|
556 |
488 |
$5.16 |
| 82962 |
|
1,324 |
1,014 |
$3.65 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
2,807 |
2,399 |
$0.00 |
| 90681 |
|
1,230 |
1,031 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
3,421 |
2,732 |
$0.00 |
| 99201 |
|
1,209 |
915 |
$0.00 |
| 99173 |
|
199 |
198 |
$0.00 |
| 90700 |
|
752 |
617 |
$0.00 |
| 81002 |
|
1,255 |
1,043 |
$0.00 |
| 90791 |
Psychiatric diagnostic evaluation |
169 |
147 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
32 |
32 |
$0.00 |
| 0502F |
|
26 |
15 |
$0.00 |
| 90713 |
|
73 |
64 |
$0.00 |
| D1120 |
Prophylaxis - child |
72 |
72 |
$0.00 |
| 91321 |
|
50 |
46 |
$0.00 |
| 90380 |
|
13 |
12 |
$0.00 |
| G8431 |
Screening for depression is documented as being positive and a follow-up plan is documented |
29 |
28 |
$0.00 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
12 |
12 |
$0.00 |
| 90647 |
|
2,422 |
1,969 |
$0.00 |
| 99383 |
|
29 |
29 |
$0.00 |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
126 |
115 |
$0.00 |
| 90677 |
|
413 |
386 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
53 |
53 |
$0.00 |
| 90723 |
|
2,326 |
1,935 |
$0.00 |
| 99385 |
|
34 |
34 |
$0.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
1,206 |
1,090 |
$0.00 |
| 99381 |
|
363 |
351 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
804 |
656 |
$0.00 |
| 90619 |
|
578 |
468 |
$0.00 |
| 90656 |
|
415 |
374 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
96 |
96 |
$0.00 |
| 92250 |
|
28 |
28 |
$0.00 |
| S5190 |
Wellness assessment, performed by non-physician |
451 |
433 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
21 |
21 |
$0.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
30 |
30 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
40 |
40 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
28 |
26 |
$0.00 |