| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
56,386 |
43,513 |
$6.86M |
| T1040 |
Medicaid certified community behavioral health clinic services, per diem |
534 |
437 |
$38K |
| 0011A |
|
743 |
661 |
$27K |
| 0012A |
|
595 |
594 |
$25K |
| 0064A |
|
196 |
185 |
$8K |
| 0001A |
|
99 |
99 |
$4K |
| 0002A |
|
89 |
89 |
$4K |
| 0134A |
|
90 |
72 |
$2K |
| 91322 |
|
16 |
13 |
$1K |
| 90651 |
|
740 |
580 |
$664.13 |
| 90620 |
|
114 |
70 |
$513.65 |
| 90734 |
|
562 |
465 |
$397.45 |
| 90670 |
|
282 |
208 |
$205.11 |
| 90480 |
|
26 |
17 |
$183.75 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
24,828 |
19,710 |
$83.51 |
| 90715 |
|
617 |
459 |
$70.72 |
| 90756 |
|
32 |
25 |
$58.38 |
| 90686 |
|
2,106 |
1,895 |
$46.83 |
| 90633 |
|
419 |
321 |
$45.69 |
| 90688 |
|
467 |
253 |
$45.00 |
| 90744 |
|
63 |
35 |
$26.14 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
475 |
379 |
$9.81 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
303 |
294 |
$0.00 |
| 90791 |
Psychiatric diagnostic evaluation |
754 |
515 |
$0.00 |
| 81025 |
|
174 |
141 |
$0.00 |
| 90832 |
Psychotherapy, 30 minutes with patient |
295 |
147 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
192 |
175 |
$0.00 |
| 90837 |
Psychotherapy, 53 minutes with patient |
556 |
397 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
889 |
758 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
1,074 |
921 |
$0.00 |
| 81002 |
|
2,170 |
1,817 |
$0.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
73 |
69 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
725 |
649 |
$0.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
230 |
181 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
772 |
644 |
$0.00 |
| 90648 |
|
55 |
52 |
$0.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
120 |
105 |
$0.00 |
| 90658 |
|
16 |
16 |
$0.00 |
| 90710 |
|
169 |
131 |
$0.00 |
| 11721 |
|
489 |
388 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
53 |
38 |
$0.00 |
| 3078F |
|
175 |
173 |
$0.00 |
| 90653 |
|
149 |
73 |
$0.00 |
| G8431 |
Screening for depression is documented as being positive and a follow-up plan is documented |
75 |
75 |
$0.00 |
| 3077F |
|
71 |
70 |
$0.00 |
| 3089F |
|
12 |
12 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
35 |
29 |
$0.00 |
| 90662 |
|
12 |
12 |
$0.00 |
| 3079F |
|
164 |
162 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
13,585 |
11,585 |
$0.00 |
| 90723 |
|
12 |
12 |
$0.00 |
| 90698 |
|
70 |
40 |
$0.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
536 |
456 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,450 |
1,105 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
457 |
444 |
$0.00 |
| 99383 |
|
48 |
38 |
$0.00 |
| 90696 |
|
154 |
107 |
$0.00 |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
64 |
60 |
$0.00 |
| 90834 |
Psychotherapy, 45 minutes with patient |
108 |
69 |
$0.00 |
| Q3014 |
Telehealth originating site facility fee |
419 |
397 |
$0.00 |
| 2000F |
|
133 |
130 |
$0.00 |
| 82962 |
|
163 |
113 |
$0.00 |
| 3080F |
|
26 |
25 |
$0.00 |
| 86580 |
|
39 |
25 |
$0.00 |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
59 |
49 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
13 |
13 |
$0.00 |
| 3074F |
|
204 |
201 |
$0.00 |
| 90656 |
|
245 |
241 |
$0.00 |
| 99384 |
|
14 |
13 |
$0.00 |
| 3075F |
|
55 |
55 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
13 |
13 |
$0.00 |
| 90732 |
|
34 |
34 |
$0.00 |