| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
2,644 |
2,566 |
$443K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
93 |
93 |
$16K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
81 |
80 |
$6K |
| 90686 |
|
309 |
309 |
$6K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
228 |
228 |
$5K |
| 99385 |
|
25 |
25 |
$4K |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
435 |
434 |
$4K |
| 90732 |
|
12 |
12 |
$1K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
69 |
69 |
$669.32 |
| 81002 |
|
227 |
226 |
$593.88 |
| 82947 |
|
128 |
127 |
$495.47 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
15 |
15 |
$177.12 |
| 91300 |
|
25 |
25 |
$0.00 |