| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
10,528 |
8,389 |
$873K |
| 59430 |
|
134 |
108 |
$5K |
| T1040 |
Medicaid certified community behavioral health clinic services, per diem |
22 |
14 |
$1K |
| 0500F |
|
227 |
223 |
$579.84 |
| 90715 |
|
180 |
176 |
$77.76 |
| 90656 |
|
118 |
111 |
$65.64 |
| 90686 |
|
97 |
85 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
194 |
188 |
$0.00 |
| 90677 |
|
227 |
209 |
$0.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
200 |
190 |
$0.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
988 |
927 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
3,504 |
3,151 |
$0.00 |
| 90723 |
|
209 |
197 |
$0.00 |
| 99215 |
Prolong outpt/office vis |
207 |
194 |
$0.00 |
| 90648 |
|
223 |
204 |
$0.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
79 |
78 |
$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) |
279 |
262 |
$0.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
389 |
367 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
137 |
133 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
2,093 |
1,380 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
648 |
551 |
$0.00 |
| 90681 |
|
136 |
127 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
13 |
13 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
14 |
14 |
$0.00 |
| 76856 |
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete |
13 |
13 |
$0.00 |