| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
9,035 |
7,606 |
$2.73M |
| S0281 |
Medical home program, comprehensive care coordination and planning, maintenance of plan |
11,451 |
11,390 |
$66K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
30 |
30 |
$5K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
3,308 |
2,911 |
$4K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,495 |
2,212 |
$546.82 |
| 87428 |
|
618 |
583 |
$334.80 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
628 |
593 |
$151.41 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
334 |
306 |
$95.60 |
| 96127 |
|
314 |
281 |
$16.41 |
| 86328 |
|
49 |
47 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
587 |
550 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
198 |
172 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
81 |
77 |
$0.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
143 |
138 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
12 |
12 |
$0.00 |
| 90461 |
|
13 |
13 |
$0.00 |
| 87807 |
|
61 |
58 |
$0.00 |
| 90619 |
|
26 |
26 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
12 |
12 |
$0.00 |
| 90651 |
|
29 |
29 |
$0.00 |