| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
1,607 |
1,518 |
$302K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
82 |
82 |
$15K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
80 |
79 |
$6K |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
526 |
524 |
$5K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
127 |
126 |
$3K |
| 90686 |
|
109 |
109 |
$2K |
| 90715 |
|
55 |
55 |
$2K |
| 90750 |
|
13 |
13 |
$1K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
13 |
13 |
$196.80 |
| 91300 |
|
12 |
12 |
$0.00 |