| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
3,738 |
2,969 |
$617K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
369 |
368 |
$64K |
| T1040 |
Medicaid certified community behavioral health clinic services, per diem |
299 |
114 |
$42K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
817 |
776 |
$8K |
| 90834 |
Psychotherapy, 45 minutes with patient |
42 |
20 |
$4K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
15 |
15 |
$3K |
| 99384 |
|
14 |
14 |
$2K |
| 81025 |
|
360 |
334 |
$2K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
80 |
80 |
$510.44 |
| 86580 |
|
62 |
61 |
$374.48 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
12 |
12 |
$114.79 |
| 90734 |
|
15 |
15 |
$0.00 |
| 91300 |
|
13 |
13 |
$0.00 |