| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
80,063 |
53,799 |
$11.25M |
| T1040 |
Medicaid certified community behavioral health clinic services, per diem |
1,154 |
786 |
$73K |
| 90686 |
|
3,204 |
2,635 |
$3K |
| 0012A |
|
50 |
33 |
$2K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
45,860 |
33,651 |
$2K |
| 0011A |
|
49 |
44 |
$2K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
4,961 |
3,465 |
$939.64 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
60 |
51 |
$395.80 |
| 90715 |
|
794 |
617 |
$328.81 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
313 |
242 |
$273.80 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
691 |
608 |
$217.75 |
| 0502F |
|
2,774 |
1,500 |
$174.30 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
4,563 |
3,010 |
$163.00 |
| 81025 |
|
1,793 |
1,515 |
$162.33 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
194 |
135 |
$78.50 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
140 |
130 |
$58.86 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
1,094 |
1,007 |
$39.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
1,458 |
1,282 |
$38.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
1,919 |
1,645 |
$35.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
1,418 |
1,139 |
$28.00 |
| 81002 |
|
755 |
590 |
$25.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
1,400 |
1,212 |
$25.00 |
| 90656 |
|
51 |
48 |
$20.64 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
524 |
488 |
$16.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,432 |
1,156 |
$5.75 |
| 90832 |
Psychotherapy, 30 minutes with patient |
2,548 |
1,839 |
$4.00 |
| 1160F |
|
16,015 |
13,738 |
$2.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
198 |
174 |
$2.00 |
| 1036F |
|
14,170 |
12,284 |
$1.00 |
| 3725F |
|
13,526 |
11,812 |
$1.00 |
| 96127 |
|
1,179 |
1,127 |
$0.00 |
| 90677 |
|
196 |
193 |
$0.00 |
| 3075F |
|
2,680 |
2,501 |
$0.00 |
| 3074F |
|
13,353 |
11,785 |
$0.00 |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
206 |
76 |
$0.00 |
| 3079F |
|
4,344 |
3,968 |
$0.00 |
| 3080F |
|
767 |
703 |
$0.00 |
| 90834 |
Psychotherapy, 45 minutes with patient |
160 |
143 |
$0.00 |
| 99385 |
|
250 |
243 |
$0.00 |
| 3008F |
|
18,054 |
15,744 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
409 |
395 |
$0.00 |
| 3044F |
|
62 |
61 |
$0.00 |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
157 |
127 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
111 |
97 |
$0.00 |
| 99383 |
|
29 |
28 |
$0.00 |
| 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 time one or more fqhc services are rendered and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving a fqhc visit |
32 |
25 |
$0.00 |
| 99384 |
|
41 |
39 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
12 |
12 |
$0.00 |
| 87428 |
|
15 |
15 |
$0.00 |
| 3052F |
|
13 |
13 |
$0.00 |
| 90791 |
Psychiatric diagnostic evaluation |
1,356 |
1,036 |
$0.00 |
| 3078F |
|
12,458 |
11,080 |
$0.00 |
| 3077F |
|
1,621 |
1,463 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
351 |
290 |
$0.00 |
| 90837 |
Psychotherapy, 53 minutes with patient |
677 |
290 |
$0.00 |
| 3046F |
|
35 |
32 |
$0.00 |
| 99201 |
|
39 |
17 |
$0.00 |