| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
39,111 |
31,038 |
$5.45M |
| T1040 |
Medicaid certified community behavioral health clinic services, per diem |
1,115 |
888 |
$57K |
| D0999 |
Unspecified diagnostic procedure, by report |
277 |
246 |
$29K |
| 0001A |
|
244 |
202 |
$10K |
| 0002A |
|
220 |
189 |
$9K |
| 0012A |
|
182 |
126 |
$7K |
| 90651 |
|
769 |
666 |
$6K |
| 0011A |
|
110 |
96 |
$4K |
| 90734 |
|
390 |
331 |
$3K |
| 90480 |
|
49 |
49 |
$2K |
| 90670 |
|
731 |
645 |
$2K |
| 0072A |
|
37 |
36 |
$2K |
| 0071A |
|
38 |
36 |
$2K |
| 90686 |
|
1,997 |
1,718 |
$947.52 |
| 90658 |
|
501 |
437 |
$637.64 |
| 0064A |
|
15 |
15 |
$632.10 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
12,453 |
10,703 |
$535.35 |
| 90633 |
|
407 |
353 |
$524.83 |
| 90710 |
|
46 |
40 |
$461.00 |
| 90715 |
|
316 |
295 |
$373.47 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
2,393 |
2,164 |
$368.36 |
| 90723 |
|
109 |
103 |
$230.92 |
| 90648 |
|
299 |
270 |
$149.76 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
5,873 |
5,033 |
$146.00 |
| 90680 |
|
304 |
283 |
$127.74 |
| 90832 |
Psychotherapy, 30 minutes with patient |
1,187 |
843 |
$119.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
6,096 |
5,466 |
$111.00 |
| 90688 |
|
265 |
255 |
$80.84 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,532 |
1,396 |
$66.03 |
| 90837 |
Psychotherapy, 53 minutes with patient |
590 |
414 |
$57.00 |
| 90696 |
|
35 |
29 |
$56.67 |
| 0502F |
|
1,829 |
1,050 |
$55.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
1,747 |
1,582 |
$54.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
2,147 |
1,948 |
$43.00 |
| 90698 |
|
57 |
48 |
$38.40 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
2,016 |
1,700 |
$38.00 |
| 90791 |
Psychiatric diagnostic evaluation |
608 |
484 |
$35.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
1,460 |
1,304 |
$22.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
385 |
341 |
$16.07 |
| 99201 |
|
303 |
288 |
$16.00 |
| 90834 |
Psychotherapy, 45 minutes with patient |
724 |
553 |
$15.00 |
| 81000 |
|
615 |
275 |
$5.24 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
450 |
433 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
820 |
815 |
$0.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
265 |
228 |
$0.00 |
| 82948 |
|
359 |
306 |
$0.00 |
| 3078F |
|
236 |
228 |
$0.00 |
| 90461 |
|
77 |
77 |
$0.00 |
| 90473 |
|
146 |
135 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
354 |
342 |
$0.00 |
| 99215 |
Prolong outpt/office vis |
90 |
68 |
$0.00 |
| 3077F |
|
83 |
78 |
$0.00 |
| 81025 |
|
111 |
108 |
$0.00 |
| 1160F |
|
16 |
16 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
16 |
16 |
$0.00 |
| 1159F |
|
15 |
15 |
$0.00 |
| D1120 |
Prophylaxis - child |
12 |
12 |
$0.00 |
| 81002 |
|
17 |
12 |
$0.00 |
| 4010F |
|
85 |
80 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
12 |
12 |
$0.00 |
| 3074F |
|
183 |
178 |
$0.00 |
| 87081 |
|
294 |
273 |
$0.00 |
| 90677 |
|
112 |
109 |
$0.00 |
| 3075F |
|
81 |
80 |
$0.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
73 |
72 |
$0.00 |
| 85018 |
|
363 |
305 |
$0.00 |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
127 |
127 |
$0.00 |
| 1036F |
|
353 |
339 |
$0.00 |
| 90620 |
|
49 |
49 |
$0.00 |
| 2000F |
|
245 |
229 |
$0.00 |
| 90619 |
|
80 |
77 |
$0.00 |
| 3079F |
|
117 |
112 |
$0.00 |
| 90656 |
|
132 |
127 |
$0.00 |
| 3008F |
|
997 |
926 |
$0.00 |
| 1126F |
|
47 |
47 |
$0.00 |
| 96127 |
|
40 |
39 |
$0.00 |