| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
111,709 |
82,279 |
$14.57M |
| T1040 |
Medicaid certified community behavioral health clinic services, per diem |
4,243 |
2,767 |
$331K |
| D0999 |
Unspecified diagnostic procedure, by report |
782 |
710 |
$107K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
59,511 |
47,549 |
$5K |
| 0011A |
|
120 |
119 |
$5K |
| 0012A |
|
103 |
103 |
$4K |
| 90716 |
|
574 |
508 |
$3K |
| 90734 |
|
963 |
813 |
$2K |
| 90651 |
|
2,057 |
1,788 |
$2K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
8,843 |
7,682 |
$2K |
| 90633 |
|
2,075 |
1,862 |
$2K |
| 90707 |
|
422 |
374 |
$1K |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
3,106 |
2,865 |
$1K |
| 90674 |
|
1,121 |
1,070 |
$740.75 |
| 0124A |
|
20 |
16 |
$710.69 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
3,184 |
2,852 |
$691.56 |
| 90715 |
|
780 |
694 |
$640.67 |
| 0002A |
|
18 |
17 |
$619.79 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
3,548 |
3,197 |
$609.39 |
| 90670 |
|
2,344 |
2,064 |
$557.53 |
| 0071A |
|
12 |
12 |
$505.68 |
| S5190 |
Wellness assessment, performed by non-physician |
311 |
276 |
$460.24 |
| 90723 |
|
1,321 |
1,100 |
$359.27 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
3,084 |
2,670 |
$347.60 |
| 90834 |
Psychotherapy, 45 minutes with patient |
7,889 |
4,581 |
$323.05 |
| 0500F |
|
1,002 |
889 |
$264.60 |
| 0502F |
|
5,497 |
3,417 |
$264.60 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
2,247 |
1,975 |
$251.55 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
2,116 |
1,903 |
$224.98 |
| 0001A |
|
13 |
13 |
$220.22 |
| 90696 |
|
448 |
402 |
$139.05 |
| 90791 |
Psychiatric diagnostic evaluation |
1,993 |
1,842 |
$132.20 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
391 |
341 |
$124.10 |
| 0503F |
|
371 |
296 |
$100.30 |
| 90698 |
|
74 |
65 |
$92.68 |
| 99381 |
|
314 |
256 |
$91.90 |
| 90686 |
|
3,134 |
2,799 |
$76.67 |
| 96127 |
|
1,297 |
1,053 |
$70.00 |
| 81002 |
|
9,358 |
6,498 |
$67.15 |
| 99215 |
Prolong outpt/office vis |
646 |
571 |
$49.95 |
| 90756 |
|
22 |
21 |
$43.50 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
2,841 |
2,535 |
$25.65 |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
371 |
329 |
$25.00 |
| 81025 |
|
2,495 |
2,101 |
$18.06 |
| 82962 |
|
2,068 |
1,623 |
$15.12 |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
264 |
255 |
$0.00 |
| 90620 |
|
207 |
194 |
$0.00 |
| 85018 |
|
1,982 |
1,710 |
$0.00 |
| 99383 |
|
603 |
549 |
$0.00 |
| 90647 |
|
984 |
809 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
3,686 |
3,255 |
$0.00 |
| 99406 |
|
204 |
174 |
$0.00 |
| 90680 |
|
1,500 |
1,296 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
186 |
186 |
$0.00 |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
14 |
14 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
86 |
86 |
$0.00 |
| 99384 |
|
350 |
326 |
$0.00 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
14 |
14 |
$0.00 |
| 90688 |
|
209 |
142 |
$0.00 |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
16 |
15 |
$0.00 |
| 90619 |
|
101 |
100 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
918 |
903 |
$0.00 |
| 99386 |
|
39 |
39 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
176 |
176 |
$0.00 |
| 90697 |
|
204 |
202 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
275 |
266 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
25 |
25 |
$0.00 |
| 90744 |
|
13 |
13 |
$0.00 |
| 86580 |
|
19 |
12 |
$0.00 |
| 90656 |
|
112 |
106 |
$0.00 |
| 99385 |
|
71 |
71 |
$0.00 |
| 90832 |
Psychotherapy, 30 minutes with patient |
1,390 |
1,013 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
2,004 |
1,801 |
$0.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
358 |
327 |
$0.00 |
| G8431 |
Screening for depression is documented as being positive and a follow-up plan is documented |
85 |
84 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
140 |
140 |
$0.00 |
| 90661 |
|
235 |
234 |
$0.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
181 |
179 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
147 |
142 |
$0.00 |
| 90837 |
Psychotherapy, 53 minutes with patient |
722 |
505 |
$0.00 |
| 90710 |
|
637 |
563 |
$0.00 |
| D1120 |
Prophylaxis - child |
220 |
220 |
$0.00 |
| 99173 |
|
114 |
92 |
$0.00 |
| 90713 |
|
61 |
60 |
$0.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
38 |
38 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
60 |
60 |
$0.00 |
| 99382 |
|
42 |
40 |
$0.00 |
| 99420 |
|
18 |
16 |
$0.00 |
| 90700 |
|
29 |
29 |
$0.00 |
| 83655 |
|
15 |
15 |
$0.00 |