| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
2,675 |
2,585 |
$503K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
267 |
266 |
$20K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
79 |
79 |
$16K |
| 90686 |
|
369 |
369 |
$8K |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
518 |
515 |
$5K |
| 90750 |
|
45 |
45 |
$4K |
| 90739 |
|
29 |
29 |
$3K |
| 90732 |
|
16 |
16 |
$2K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
79 |
79 |
$2K |
| 90715 |
|
47 |
47 |
$2K |
| 91313 |
|
12 |
12 |
$0.00 |