| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
77,257 |
61,734 |
$10.68M |
| T1040 |
Medicaid certified community behavioral health clinic services, per diem |
23 |
15 |
$2K |
| 90651 |
|
3,186 |
2,720 |
$1K |
| 0503F |
|
119 |
108 |
$975.00 |
| 90670 |
|
8,097 |
7,445 |
$562.52 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
18,917 |
16,614 |
$534.01 |
| 97803 |
|
14,005 |
11,905 |
$529.00 |
| G0447 |
Face-to-face behavioral counseling for obesity, 15 minutes |
13,048 |
10,875 |
$495.00 |
| 97802 |
|
14,929 |
12,766 |
$478.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
8,499 |
7,323 |
$461.00 |
| 90633 |
|
5,381 |
4,809 |
$376.93 |
| 92551 |
|
11,291 |
9,904 |
$360.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
16,281 |
13,843 |
$357.35 |
| Q3014 |
Telehealth originating site facility fee |
5,830 |
5,142 |
$320.84 |
| 99173 |
|
14,648 |
12,994 |
$319.76 |
| 0500F |
|
88 |
88 |
$289.92 |
| 90734 |
|
2,532 |
2,183 |
$288.76 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
8,489 |
7,826 |
$282.75 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
184 |
152 |
$265.60 |
| 96127 |
|
19,451 |
12,946 |
$242.00 |
| 99384 |
|
595 |
497 |
$221.92 |
| 99383 |
|
1,165 |
1,015 |
$218.20 |
| 90620 |
|
1,431 |
1,233 |
$192.40 |
| 90723 |
|
7,286 |
6,703 |
$188.80 |
| 90647 |
|
5,977 |
5,484 |
$180.70 |
| 90686 |
|
4,964 |
4,485 |
$160.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
10,414 |
9,368 |
$159.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
6,215 |
5,646 |
$132.00 |
| 90680 |
|
5,101 |
4,722 |
$118.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
4,622 |
4,151 |
$92.00 |
| 90700 |
|
1,848 |
1,667 |
$85.80 |
| 90710 |
|
1,816 |
1,591 |
$75.80 |
| G0008 |
Administration of influenza virus vaccine |
2,132 |
1,882 |
$70.40 |
| 90715 |
|
1,197 |
1,031 |
$70.37 |
| 90696 |
|
1,567 |
1,380 |
$40.40 |
| 90716 |
|
2,330 |
2,123 |
$39.00 |
| 90707 |
|
2,269 |
2,075 |
$35.00 |
| 99381 |
|
2,627 |
2,512 |
$23.00 |
| 90791 |
Psychiatric diagnostic evaluation |
1,189 |
1,001 |
$16.00 |
| 99382 |
|
370 |
315 |
$11.00 |
| 81002 |
|
237 |
213 |
$9.00 |
| 94150 |
|
547 |
439 |
$6.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
3,260 |
3,027 |
$3.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
340 |
294 |
$0.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
179 |
178 |
$0.00 |
| 90832 |
Psychotherapy, 30 minutes with patient |
2,369 |
906 |
$0.00 |
| 90713 |
|
74 |
59 |
$0.00 |
| 3078F |
|
802 |
693 |
$0.00 |
| 0502F |
|
314 |
218 |
$0.00 |
| 81025 |
|
2,080 |
1,942 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
341 |
319 |
$0.00 |
| 99215 |
Prolong outpt/office vis |
153 |
145 |
$0.00 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
381 |
289 |
$0.00 |
| 90837 |
Psychotherapy, 53 minutes with patient |
171 |
75 |
$0.00 |
| 90648 |
|
21 |
15 |
$0.00 |
| 90685 |
|
30 |
29 |
$0.00 |
| 1126F |
|
1,094 |
941 |
$0.00 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
222 |
213 |
$0.00 |
| 3074F |
|
848 |
728 |
$0.00 |
| 90656 |
|
227 |
220 |
$0.00 |
| 90677 |
|
546 |
535 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
1,324 |
1,159 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
2,585 |
2,305 |
$0.00 |
| 90834 |
Psychotherapy, 45 minutes with patient |
1,114 |
406 |
$0.00 |
| 99385 |
|
42 |
40 |
$0.00 |
| 92587 |
|
119 |
110 |
$0.00 |
| 85018 |
|
44 |
42 |
$0.00 |
| 3079F |
|
103 |
96 |
$0.00 |
| 1125F |
|
26 |
26 |
$0.00 |
| 17250 |
|
28 |
25 |
$0.00 |
| 90733 |
|
26 |
23 |
$0.00 |
| 90744 |
|
13 |
12 |
$0.00 |
| 3075F |
|
45 |
44 |
$0.00 |