| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
27,316 |
21,280 |
$3.34M |
| T1040 |
Medicaid certified community behavioral health clinic services, per diem |
478 |
384 |
$36K |
| 90734 |
|
171 |
112 |
$137.15 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
8,176 |
6,743 |
$0.00 |
| 90686 |
|
634 |
582 |
$0.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
8,879 |
7,379 |
$0.00 |
| 90696 |
|
15 |
15 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
265 |
218 |
$0.00 |
| 90651 |
|
257 |
181 |
$0.00 |
| 90688 |
|
52 |
37 |
$0.00 |
| 90834 |
Psychotherapy, 45 minutes with patient |
238 |
213 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
121 |
118 |
$0.00 |
| 99406 |
|
48 |
29 |
$0.00 |
| 2000F |
|
41 |
40 |
$0.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
237 |
230 |
$0.00 |
| 3074F |
|
18 |
18 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
166 |
117 |
$0.00 |
| 0502F |
|
1,083 |
580 |
$0.00 |
| 90633 |
|
162 |
129 |
$0.00 |
| 90837 |
Psychotherapy, 53 minutes with patient |
760 |
622 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
222 |
179 |
$0.00 |
| 81002 |
|
70 |
58 |
$0.00 |
| 90670 |
|
166 |
149 |
$0.00 |
| 90791 |
Psychiatric diagnostic evaluation |
155 |
122 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
363 |
301 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
426 |
364 |
$0.00 |
| 81025 |
|
181 |
129 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
268 |
235 |
$0.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
131 |
127 |
$0.00 |
| 99215 |
Prolong outpt/office vis |
93 |
86 |
$0.00 |
| 90648 |
|
27 |
24 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
93 |
92 |
$0.00 |
| 90715 |
|
118 |
87 |
$0.00 |
| 3078F |
|
12 |
12 |
$0.00 |
| 90710 |
|
17 |
16 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
13 |
13 |
$0.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
13 |
13 |
$0.00 |