| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
29,633 |
23,469 |
$2.17M |
| T1040 |
Medicaid certified community behavioral health clinic services, per diem |
135 |
81 |
$8K |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
1,687 |
1,406 |
$5K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
13,556 |
11,695 |
$5K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
5,788 |
4,427 |
$3K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
505 |
481 |
$0.00 |
| 90633 |
|
106 |
106 |
$0.00 |
| 90837 |
Psychotherapy, 53 minutes with patient |
50 |
30 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
70 |
70 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
463 |
457 |
$0.00 |
| 90700 |
|
29 |
29 |
$0.00 |
| 90461 |
|
364 |
364 |
$0.00 |
| 90833 |
Psychotherapy, 30 minutes with patient when performed with an E&M service (add-on) |
60 |
52 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
451 |
451 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
202 |
201 |
$0.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
49 |
47 |
$0.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
54 |
53 |
$0.00 |
| 90707 |
|
43 |
43 |
$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) |
2,849 |
2,588 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
690 |
601 |
$0.00 |
| 90710 |
|
46 |
46 |
$0.00 |
| 90681 |
|
72 |
72 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
21 |
21 |
$0.00 |
| 90734 |
|
23 |
23 |
$0.00 |
| 90715 |
|
16 |
16 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
28 |
28 |
$0.00 |
| 90791 |
Psychiatric diagnostic evaluation |
14 |
14 |
$0.00 |
| 90696 |
|
45 |
45 |
$0.00 |
| 87807 |
|
16 |
13 |
$0.00 |
| 90723 |
|
195 |
195 |
$0.00 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
15 |
14 |
$0.00 |
| 90656 |
|
32 |
32 |
$0.00 |
| 90647 |
|
201 |
197 |
$0.00 |
| S5190 |
Wellness assessment, performed by non-physician |
26 |
25 |
$0.00 |
| 99383 |
|
14 |
13 |
$0.00 |
| 90651 |
|
25 |
25 |
$0.00 |
| 90716 |
|
17 |
17 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
23 |
23 |
$0.00 |
| 99381 |
|
12 |
12 |
$0.00 |