| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
1,107 |
1,088 |
$177K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
204 |
203 |
$15K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
81 |
81 |
$14K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
254 |
254 |
$5K |
| 90715 |
|
148 |
148 |
$5K |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
454 |
453 |
$4K |
| 90686 |
|
203 |
203 |
$3K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
41 |
41 |
$452.64 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
19 |
19 |
$224.39 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
15 |
15 |
$177.15 |
| 81002 |
|
33 |
33 |
$87.12 |