| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
4,130 |
2,793 |
$585K |
| T1040 |
Medicaid certified community behavioral health clinic services, per diem |
256 |
150 |
$13K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
889 |
697 |
$640.43 |
| 90832 |
Psychotherapy, 30 minutes with patient |
328 |
216 |
$29.48 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,373 |
1,112 |
$25.65 |
| 96127 |
|
409 |
397 |
$0.00 |
| 85018 |
|
26 |
25 |
$0.00 |
| 90620 |
|
106 |
105 |
$0.00 |
| 90686 |
|
32 |
31 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
52 |
45 |
$0.00 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
13 |
13 |
$0.00 |
| 90656 |
|
31 |
31 |
$0.00 |
| 99173 |
|
458 |
423 |
$0.00 |
| 81025 |
|
168 |
143 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
244 |
243 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
104 |
103 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
23 |
23 |
$0.00 |
| 90734 |
|
13 |
13 |
$0.00 |