| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
5,138 |
4,797 |
$878K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
1,219 |
1,218 |
$215K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
1,001 |
1,001 |
$179K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
4,279 |
4,262 |
$167K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
897 |
895 |
$160K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
471 |
455 |
$85K |
| 99173 |
|
2,057 |
2,057 |
$46K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
4,511 |
4,473 |
$46K |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
4,752 |
4,711 |
$43K |
| 92551 |
|
2,213 |
2,213 |
$22K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
14 |
14 |
$2K |
| 90651 |
|
422 |
422 |
$2K |
| 90686 |
|
1,977 |
1,976 |
$1K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
102 |
102 |
$1K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
56 |
55 |
$661.36 |
| 90734 |
|
482 |
482 |
$654.10 |
| 90670 |
|
565 |
565 |
$384.00 |
| 99188 |
|
14 |
14 |
$364.00 |
| 90715 |
|
119 |
118 |
$257.47 |
| 90649 |
|
19 |
19 |
$137.59 |
| 90633 |
|
488 |
488 |
$0.00 |
| 90710 |
|
68 |
68 |
$0.00 |
| 90716 |
|
14 |
14 |
$0.00 |