| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
121,097 |
91,460 |
$16.38M |
| T1040 |
Medicaid certified community behavioral health clinic services, per diem |
130 |
94 |
$10K |
| 59430 |
|
316 |
301 |
$5K |
| 0001A |
|
44 |
44 |
$2K |
| 0124A |
|
63 |
57 |
$2K |
| 90651 |
|
1,858 |
1,621 |
$1K |
| 90670 |
|
5,704 |
4,908 |
$1K |
| 0002A |
|
29 |
28 |
$1K |
| 0503F |
|
1,068 |
921 |
$975.00 |
| 0500F |
|
2,872 |
2,608 |
$879.76 |
| 90715 |
|
3,524 |
3,107 |
$561.01 |
| 0003A |
|
13 |
13 |
$547.82 |
| 90633 |
|
3,495 |
3,029 |
$308.30 |
| 90716 |
|
1,655 |
1,396 |
$264.12 |
| 90734 |
|
1,231 |
1,106 |
$264.10 |
| 90707 |
|
1,645 |
1,388 |
$229.68 |
| 90710 |
|
1,409 |
1,183 |
$214.37 |
| 90648 |
|
5,317 |
4,485 |
$172.46 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
825 |
753 |
$144.72 |
| 90688 |
|
679 |
425 |
$135.00 |
| 90723 |
|
3,981 |
3,373 |
$70.80 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
45,266 |
35,921 |
$56.70 |
| 90696 |
|
1,179 |
1,003 |
$53.13 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
15,717 |
13,256 |
$42.50 |
| G2012 |
Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion |
25 |
19 |
$13.19 |
| 90658 |
|
51 |
50 |
$6.40 |
| 81002 |
|
1,215 |
1,054 |
$0.00 |
| 90681 |
|
3,211 |
2,860 |
$0.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
1,817 |
1,679 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
7,963 |
6,909 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
3,497 |
3,251 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
524 |
493 |
$0.00 |
| 11721 |
|
221 |
187 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
1,339 |
1,192 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
2,716 |
2,415 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
4,562 |
4,029 |
$0.00 |
| 81025 |
|
4,787 |
4,174 |
$0.00 |
| G8431 |
Screening for depression is documented as being positive and a follow-up plan is documented |
83 |
78 |
$0.00 |
| J3301 |
Injection, triamcinolone acetonide, not otherwise specified, 10 mg |
129 |
120 |
$0.00 |
| 99201 |
|
85 |
61 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
6,967 |
6,036 |
$0.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
253 |
249 |
$0.00 |
| 90700 |
|
1,039 |
930 |
$0.00 |
| 0502F |
|
13,014 |
7,706 |
$0.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
241 |
239 |
$0.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
203 |
199 |
$0.00 |
| 90671 |
|
1,319 |
1,124 |
$0.00 |
| 96379 |
|
85 |
79 |
$0.00 |
| 3077F |
|
24 |
23 |
$0.00 |
| 3089F |
|
14 |
12 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
44 |
18 |
$0.00 |
| 90380 |
|
20 |
19 |
$0.00 |
| 90653 |
|
164 |
94 |
$0.00 |
| 90686 |
|
5,908 |
5,208 |
$0.00 |
| 99383 |
|
41 |
41 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
2,943 |
2,411 |
$0.00 |
| Q3014 |
Telehealth originating site facility fee |
2,309 |
1,675 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
1,101 |
1,055 |
$0.00 |
| 2000F |
|
44 |
44 |
$0.00 |
| 90620 |
|
255 |
235 |
$0.00 |
| 99381 |
|
1,722 |
1,553 |
$0.00 |
| 90697 |
|
1,613 |
1,565 |
$0.00 |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
178 |
172 |
$0.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
427 |
287 |
$0.00 |
| 96127 |
|
168 |
160 |
$0.00 |
| 90732 |
|
43 |
41 |
$0.00 |
| 90656 |
|
539 |
509 |
$0.00 |
| 57454 |
|
21 |
13 |
$0.00 |
| 20610 |
|
165 |
123 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
14 |
14 |
$0.00 |
| 90381 |
|
169 |
146 |
$0.00 |
| 90677 |
|
13 |
12 |
$0.00 |
| 3092F |
|
12 |
12 |
$0.00 |
| 86580 |
|
15 |
13 |
$0.00 |
| 3008F |
|
46 |
45 |
$0.00 |
| 58100 |
|
12 |
12 |
$0.00 |
| 3080F |
|
16 |
15 |
$0.00 |