| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
21,901 |
17,731 |
$1.98M |
| T1040 |
Medicaid certified community behavioral health clinic services, per diem |
548 |
344 |
$36K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
5,584 |
4,945 |
$210.96 |
| 90686 |
|
137 |
96 |
$203.22 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
9,931 |
8,553 |
$47.16 |
| 87428 |
|
239 |
223 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
59 |
45 |
$0.00 |
| 90656 |
|
12 |
12 |
$0.00 |
| 96127 |
|
63 |
57 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
1,156 |
1,019 |
$0.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
570 |
503 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
85 |
82 |
$0.00 |
| 90832 |
Psychotherapy, 30 minutes with patient |
529 |
322 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
80 |
80 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
114 |
111 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
86 |
80 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
265 |
219 |
$0.00 |
| 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) |
76 |
74 |
$0.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
14 |
12 |
$0.00 |
| 90791 |
Psychiatric diagnostic evaluation |
12 |
12 |
$0.00 |