| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
178 |
164 |
$29K |
| 99385 |
|
27 |
27 |
$5K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
13 |
13 |
$2K |
| 90651 |
|
12 |
12 |
$1K |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
100 |
100 |
$905.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
43 |
43 |
$879.35 |
| 90715 |
|
25 |
25 |
$737.15 |
| 99173 |
|
19 |
19 |
$426.93 |
| 90686 |
|
19 |
19 |
$266.42 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
18 |
18 |
$184.86 |
| 92551 |
|
17 |
17 |
$168.81 |