| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
4,932 |
2,531 |
$477K |
| 0011A |
|
78 |
78 |
$3K |
| 0124A |
|
65 |
65 |
$3K |
| 0004A |
|
30 |
30 |
$1K |
| 90686 |
|
175 |
144 |
$1K |
| 0012A |
|
21 |
21 |
$884.94 |
| 0001A |
|
12 |
12 |
$505.68 |
| 81025 |
|
194 |
100 |
$18.08 |
| 3008F |
|
1,353 |
762 |
$0.00 |
| 96127 |
|
1,288 |
577 |
$0.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,146 |
1,185 |
$0.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
478 |
347 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
844 |
584 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
719 |
392 |
$0.00 |
| 3074F |
|
13 |
12 |
$0.00 |
| 36416 |
|
24 |
12 |
$0.00 |
| S5190 |
Wellness assessment, performed by non-physician |
40 |
40 |
$0.00 |
| G8420 |
Bmi is documented within normal parameters and no follow-up plan is required |
50 |
14 |
$0.00 |
| H0050 |
Alcohol and/or drug services, brief intervention, per 15 minutes |
704 |
194 |
$0.00 |
| G8417 |
Bmi is documented above normal parameters and a follow-up plan is documented |
777 |
426 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
299 |
206 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
111 |
63 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
95 |
79 |
$0.00 |
| 90670 |
|
44 |
25 |
$0.00 |
| 81002 |
|
78 |
25 |
$0.00 |
| 90832 |
Psychotherapy, 30 minutes with patient |
38 |
29 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
50 |
25 |
$0.00 |