| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
109,425 |
70,338 |
$7.88M |
| T1040 |
Medicaid certified community behavioral health clinic services, per diem |
5,014 |
2,958 |
$317K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
35,652 |
24,222 |
$294.22 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
31,946 |
23,429 |
$127.50 |
| 90682 |
|
135 |
83 |
$56.01 |
| 90686 |
|
767 |
599 |
$19.03 |
| 90633 |
|
417 |
309 |
$6.40 |
| 90734 |
|
298 |
201 |
$6.40 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
5,029 |
4,038 |
$0.00 |
| 11721 |
|
295 |
278 |
$0.00 |
| 3078F |
|
7,591 |
5,662 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
816 |
641 |
$0.00 |
| 3077F |
|
2,478 |
1,956 |
$0.00 |
| 2028F |
|
147 |
140 |
$0.00 |
| 90670 |
|
892 |
723 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
1,156 |
943 |
$0.00 |
| 3725F |
|
732 |
509 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
1,064 |
891 |
$0.00 |
| 4004F |
|
839 |
661 |
$0.00 |
| 90791 |
Psychiatric diagnostic evaluation |
301 |
285 |
$0.00 |
| 4013F |
|
2,502 |
1,721 |
$0.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
221 |
195 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
1,665 |
1,322 |
$0.00 |
| 90715 |
|
391 |
288 |
$0.00 |
| 90837 |
Psychotherapy, 53 minutes with patient |
3,076 |
1,774 |
$0.00 |
| 99215 |
Prolong outpt/office vis |
129 |
112 |
$0.00 |
| G0511 |
Rural health clinic or federally qualified health center (rhc or fqhc) only, general care management, 20 minutes or more of clinical staff time for chronic care management services or behavioral health integration services directed by an rhc or fqhc practitioner (physician, np, pa, or cnm), per calendar month |
158 |
158 |
$0.00 |
| 90710 |
|
168 |
143 |
$0.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
79 |
57 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
552 |
470 |
$0.00 |
| 1160F |
|
147 |
134 |
$0.00 |
| J3301 |
Injection, triamcinolone acetonide, not otherwise specified, 10 mg |
92 |
51 |
$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) |
79 |
79 |
$0.00 |
| 81025 |
|
190 |
179 |
$0.00 |
| 95251 |
|
16 |
12 |
$0.00 |
| 99244 |
Office or other outpatient consultation, moderate to high complexity |
136 |
125 |
$0.00 |
| 90700 |
|
112 |
76 |
$0.00 |
| 90648 |
|
25 |
25 |
$0.00 |
| 90649 |
|
125 |
52 |
$0.00 |
| 90707 |
|
72 |
47 |
$0.00 |
| Q0091 |
Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory |
25 |
25 |
$0.00 |
| 83037 |
|
155 |
56 |
$0.00 |
| 90621 |
|
33 |
13 |
$0.00 |
| 90713 |
|
36 |
17 |
$0.00 |
| 1159F |
|
17 |
13 |
$0.00 |
| 90661 |
|
16 |
16 |
$0.00 |
| 90834 |
Psychotherapy, 45 minutes with patient |
1,217 |
905 |
$0.00 |
| 4086F |
|
853 |
567 |
$0.00 |
| 3075F |
|
3,010 |
2,479 |
$0.00 |
| 1126F |
|
182 |
170 |
$0.00 |
| 3008F |
|
31,642 |
22,398 |
$0.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
1,258 |
1,050 |
$0.00 |
| 3079F |
|
5,072 |
4,043 |
$0.00 |
| 90716 |
|
93 |
61 |
$0.00 |
| 90680 |
|
292 |
246 |
$0.00 |
| 2000F |
|
4,417 |
3,048 |
$0.00 |
| 4010F |
|
2,369 |
1,666 |
$0.00 |
| 4000F |
|
249 |
213 |
$0.00 |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
890 |
820 |
$0.00 |
| 1036F |
|
12,837 |
9,553 |
$0.00 |
| 3074F |
|
8,686 |
6,333 |
$0.00 |
| 96127 |
|
421 |
354 |
$0.00 |
| 90677 |
|
215 |
195 |
$0.00 |
| 1034F |
|
5,297 |
3,898 |
$0.00 |
| 1000F |
|
157 |
148 |
$0.00 |
| Q3014 |
Telehealth originating site facility fee |
431 |
159 |
$0.00 |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
93 |
64 |
$0.00 |
| 90619 |
|
185 |
180 |
$0.00 |
| 3080F |
|
1,472 |
1,161 |
$0.00 |
| 1035F |
|
586 |
412 |
$0.00 |
| 90647 |
|
34 |
30 |
$0.00 |
| 4008F |
|
910 |
604 |
$0.00 |
| 3044F |
|
13 |
13 |
$0.00 |
| 1125F |
|
51 |
50 |
$0.00 |
| J3420 |
Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg |
48 |
41 |
$0.00 |
| 90698 |
|
51 |
37 |
$0.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
222 |
119 |
$0.00 |
| 90697 |
|
103 |
90 |
$0.00 |
| 90656 |
|
48 |
48 |
$0.00 |
| 90651 |
|
160 |
158 |
$0.00 |
| 90696 |
|
106 |
90 |
$0.00 |
| 90744 |
|
12 |
12 |
$0.00 |
| 90723 |
|
12 |
12 |
$0.00 |