| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
1,896 |
1,827 |
$351K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
220 |
220 |
$17K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
42 |
42 |
$7K |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
512 |
512 |
$5K |
| 90686 |
|
234 |
234 |
$5K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
102 |
102 |
$2K |
| 90750 |
|
13 |
13 |
$1K |
| 90715 |
|
12 |
12 |
$411.36 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
12 |
12 |
$106.32 |