| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
40,848 |
30,802 |
$6.96M |
| T1040 |
Medicaid certified community behavioral health clinic services, per diem |
1,347 |
964 |
$93K |
| D0999 |
Unspecified diagnostic procedure, by report |
96 |
77 |
$11K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
22,792 |
18,539 |
$6K |
| 91320 |
|
17 |
17 |
$2K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
4,564 |
4,190 |
$2K |
| 0124A |
|
15 |
14 |
$610.40 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
3,236 |
3,094 |
$517.37 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
1,091 |
1,050 |
$282.40 |
| 0502F |
|
1,756 |
1,025 |
$264.60 |
| 90480 |
|
13 |
13 |
$198.25 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
2,229 |
2,086 |
$198.20 |
| 90715 |
|
394 |
374 |
$89.31 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
547 |
532 |
$76.84 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
1,126 |
1,004 |
$32.15 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
13 |
13 |
$32.00 |
| 90686 |
|
750 |
719 |
$19.58 |
| 90723 |
|
532 |
486 |
$19.20 |
| 90648 |
|
763 |
692 |
$19.20 |
| 90670 |
|
582 |
543 |
$12.80 |
| 80305 |
|
287 |
271 |
$8.98 |
| S5190 |
Wellness assessment, performed by non-physician |
23 |
13 |
$7.00 |
| 81003 |
|
2,794 |
2,029 |
$6.54 |
| 90656 |
|
256 |
245 |
$0.00 |
| 90677 |
|
249 |
232 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
145 |
132 |
$0.00 |
| 82962 |
|
430 |
405 |
$0.00 |
| 90716 |
|
303 |
287 |
$0.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
374 |
370 |
$0.00 |
| 81000 |
|
60 |
58 |
$0.00 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
205 |
199 |
$0.00 |
| 90651 |
|
229 |
214 |
$0.00 |
| 90696 |
|
78 |
75 |
$0.00 |
| 96127 |
|
28 |
28 |
$0.00 |
| 90832 |
Psychotherapy, 30 minutes with patient |
1,719 |
1,294 |
$0.00 |
| 90734 |
|
225 |
204 |
$0.00 |
| 81025 |
|
930 |
878 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
1,174 |
1,139 |
$0.00 |
| 90707 |
|
312 |
295 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
1,165 |
1,115 |
$0.00 |
| 90633 |
|
344 |
332 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
440 |
421 |
$0.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
139 |
138 |
$0.00 |
| 99382 |
|
12 |
12 |
$0.00 |
| 90681 |
|
69 |
49 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
54 |
54 |
$0.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
13 |
13 |
$0.00 |
| 90700 |
|
17 |
17 |
$0.00 |