| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
13,667 |
9,502 |
$1.63M |
| T1040 |
Medicaid certified community behavioral health clinic services, per diem |
93 |
74 |
$7K |
| 90734 |
|
685 |
622 |
$1K |
| 90651 |
|
816 |
792 |
$627.41 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,496 |
2,016 |
$531.17 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
452 |
330 |
$212.50 |
| 90686 |
|
1,298 |
1,252 |
$190.30 |
| 90832 |
Psychotherapy, 30 minutes with patient |
3,659 |
1,801 |
$176.88 |
| 90715 |
|
228 |
226 |
$96.81 |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
32 |
30 |
$84.00 |
| 90791 |
Psychiatric diagnostic evaluation |
213 |
160 |
$70.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,306 |
1,211 |
$24.96 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
393 |
379 |
$16.08 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
60 |
59 |
$9.81 |
| 81025 |
|
262 |
159 |
$7.74 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
648 |
624 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
1,200 |
1,144 |
$0.00 |
| 90633 |
|
244 |
234 |
$0.00 |
| 99173 |
|
254 |
252 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
243 |
235 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
30 |
30 |
$0.00 |
| 99201 |
|
43 |
43 |
$0.00 |
| 81002 |
|
41 |
25 |
$0.00 |
| 90619 |
|
387 |
374 |
$0.00 |
| 96127 |
|
1,087 |
931 |
$0.00 |
| 90620 |
|
711 |
700 |
$0.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
205 |
201 |
$0.00 |
| S5190 |
Wellness assessment, performed by non-physician |
25 |
25 |
$0.00 |
| 99383 |
|
46 |
42 |
$0.00 |
| 90677 |
|
14 |
12 |
$0.00 |
| 90647 |
|
13 |
13 |
$0.00 |
| 99384 |
|
31 |
31 |
$0.00 |
| 90656 |
|
172 |
161 |
$0.00 |
| 90744 |
|
13 |
13 |
$0.00 |