| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
5,155 |
5,016 |
$900K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
1,050 |
1,048 |
$80K |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
1,468 |
1,465 |
$13K |
| 90677 |
|
33 |
33 |
$9K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
30 |
29 |
$5K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
30 |
30 |
$613.50 |
| 90686 |
|
29 |
29 |
$577.37 |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
12 |
12 |
$14.26 |