| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
17,683 |
13,587 |
$1.42M |
| T1040 |
Medicaid certified community behavioral health clinic services, per diem |
919 |
605 |
$67K |
| 91320 |
|
63 |
54 |
$9K |
| 90480 |
|
38 |
35 |
$579.50 |
| 90715 |
|
121 |
101 |
$91.97 |
| 90686 |
|
792 |
589 |
$22.35 |
| G2211 |
Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient's single, serious condition or a complex condition. (add-on code, list separately in addition to office/outpatient evaluation and management visit, new or established) |
1,326 |
1,157 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
470 |
428 |
$0.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
126 |
108 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
879 |
715 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
734 |
648 |
$0.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
395 |
323 |
$0.00 |
| 90734 |
|
208 |
177 |
$0.00 |
| 90791 |
Psychiatric diagnostic evaluation |
105 |
104 |
$0.00 |
| 90633 |
|
359 |
287 |
$0.00 |
| 90681 |
|
124 |
120 |
$0.00 |
| 90670 |
|
228 |
163 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
435 |
389 |
$0.00 |
| 90648 |
|
657 |
531 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
27 |
24 |
$0.00 |
| 90832 |
Psychotherapy, 30 minutes with patient |
674 |
473 |
$0.00 |
| 90707 |
|
22 |
12 |
$0.00 |
| 99215 |
Prolong outpt/office vis |
59 |
50 |
$0.00 |
| 90710 |
|
55 |
45 |
$0.00 |
| 90700 |
|
12 |
12 |
$0.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,736 |
2,223 |
$0.00 |
| 90723 |
|
525 |
418 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
8,480 |
6,549 |
$0.00 |
| 90677 |
|
434 |
395 |
$0.00 |
| 90656 |
|
386 |
378 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
508 |
414 |
$0.00 |
| 90680 |
|
223 |
158 |
$0.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
1,128 |
1,000 |
$0.00 |
| 90696 |
|
50 |
44 |
$0.00 |
| 90651 |
|
186 |
147 |
$0.00 |
| 90716 |
|
43 |
25 |
$0.00 |