| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
27,682 |
18,496 |
$2.16M |
| T1040 |
Medicaid certified community behavioral health clinic services, per diem |
524 |
376 |
$38K |
| 59430 |
|
28 |
27 |
$975.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
10,182 |
7,655 |
$139.68 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
3,088 |
2,065 |
$51.30 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
91 |
90 |
$0.00 |
| 90791 |
Psychiatric diagnostic evaluation |
13 |
13 |
$0.00 |
| 0502F |
|
678 |
321 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
50 |
50 |
$0.00 |
| 90837 |
Psychotherapy, 53 minutes with patient |
348 |
226 |
$0.00 |
| 81002 |
|
647 |
447 |
$0.00 |
| 93010 |
Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only |
65 |
65 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
112 |
91 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
80 |
72 |
$0.00 |
| 81003 |
|
17 |
17 |
$0.00 |
| 3077F |
|
117 |
106 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
26 |
25 |
$0.00 |
| 3078F |
|
1,444 |
1,116 |
$0.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
54 |
51 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
103 |
95 |
$0.00 |
| 90832 |
Psychotherapy, 30 minutes with patient |
17 |
15 |
$0.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
36 |
26 |
$0.00 |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
17 |
16 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,833 |
2,385 |
$0.00 |
| 87651 |
Infectious agent detection by nucleic acid; Streptococcus, group A, amplified probe |
32 |
32 |
$0.00 |
| 3079F |
|
284 |
260 |
$0.00 |
| 90834 |
Psychotherapy, 45 minutes with patient |
124 |
94 |
$0.00 |
| 3008F |
|
1,292 |
1,026 |
$0.00 |
| 76830 |
Ultrasound, transvaginal |
45 |
42 |
$0.00 |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
17 |
17 |
$0.00 |
| 3075F |
|
216 |
198 |
$0.00 |
| 88142 |
|
75 |
67 |
$0.00 |
| 3074F |
|
1,422 |
1,097 |
$0.00 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
47 |
39 |
$0.00 |
| 96127 |
|
64 |
46 |
$0.00 |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
21 |
16 |
$0.00 |