| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
103,927 |
88,128 |
$20.09M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
62,661 |
54,549 |
$999K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
14,539 |
13,520 |
$234K |
| H0043 |
Supported housing, per diem |
398 |
398 |
$156K |
| H0044 |
Supported housing, per month |
24 |
24 |
$99K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
6,038 |
5,699 |
$68K |
| G9920 |
Screening performed and negative |
683 |
680 |
$24K |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
232 |
140 |
$20K |
| 59025 |
Fetal non-stress test |
607 |
239 |
$19K |
| 81002 |
|
5,596 |
4,800 |
$17K |
| 0011A |
|
455 |
238 |
$17K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
316 |
316 |
$16K |
| 0012A |
|
282 |
143 |
$13K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
771 |
769 |
$12K |
| G9012 |
Other specified case management service not elsewhere classified |
72 |
72 |
$11K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
109 |
109 |
$11K |
| 90686 |
|
1,121 |
1,117 |
$10K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,183 |
1,172 |
$10K |
| 99188 |
|
457 |
449 |
$10K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
338 |
327 |
$9K |
| 81025 |
|
1,779 |
1,731 |
$7K |
| 20610 |
|
107 |
96 |
$6K |
| 99173 |
|
1,562 |
1,556 |
$6K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
219 |
219 |
$5K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
145 |
145 |
$5K |
| 90746 |
|
67 |
66 |
$4K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
484 |
483 |
$4K |
| 92250 |
|
74 |
74 |
$3K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
1,033 |
996 |
$3K |
| 0001A |
|
53 |
27 |
$3K |
| 90832 |
Psychotherapy, 30 minutes with patient |
47 |
39 |
$2K |
| 90715 |
|
152 |
152 |
$2K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
459 |
459 |
$2K |
| H1003 |
Prenatal care, at-risk enhanced service; education |
44 |
44 |
$1K |
| 92551 |
|
1,537 |
1,532 |
$1K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
172 |
171 |
$1K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
153 |
153 |
$1K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
326 |
323 |
$1K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
26 |
26 |
$1K |
| 99381 |
|
14 |
14 |
$685.44 |
| 90670 |
|
356 |
355 |
$606.00 |
| J3301 |
Injection, triamcinolone acetonide, not otherwise specified, 10 mg |
189 |
174 |
$549.54 |
| D1206 |
Topical application of fluoride varnish |
19 |
19 |
$450.00 |
| 99384 |
|
28 |
28 |
$412.55 |
| 90723 |
|
283 |
282 |
$165.80 |
| 90734 |
|
144 |
144 |
$143.00 |
| 90647 |
|
277 |
276 |
$141.60 |
| 86580 |
|
26 |
24 |
$87.70 |
| 88720 |
|
15 |
13 |
$81.30 |
| 90651 |
|
221 |
221 |
$76.70 |
| 99383 |
|
12 |
12 |
$65.96 |
| 90680 |
|
26 |
26 |
$44.00 |
| 90677 |
|
58 |
58 |
$37.80 |
| 90707 |
|
25 |
25 |
$13.00 |
| 90710 |
|
59 |
59 |
$13.00 |
| 90716 |
|
13 |
13 |
$9.00 |
| 90681 |
|
29 |
29 |
$8.00 |
| 90700 |
|
14 |
14 |
$4.00 |
| 1160F |
|
49 |
47 |
$0.00 |
| 3078F |
|
269 |
259 |
$0.00 |
| 1159F |
|
144 |
140 |
$0.00 |
| 3016F |
|
26 |
26 |
$0.00 |
| 1124F |
|
76 |
76 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
25 |
24 |
$0.00 |
| 3725F |
|
14 |
14 |
$0.00 |
| 3008F |
|
553 |
533 |
$0.00 |
| 1036F |
|
205 |
199 |
$0.00 |
| 3074F |
|
244 |
235 |
$0.00 |
| 2010F |
|
17 |
16 |
$0.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
59 |
57 |
$0.00 |
| 99386 |
|
57 |
57 |
$0.00 |
| 3079F |
|
12 |
12 |
$0.00 |