| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
81,220 |
50,925 |
$11.33M |
| T1040 |
Medicaid certified community behavioral health clinic services, per diem |
3,033 |
2,149 |
$196K |
| D0999 |
Unspecified diagnostic procedure, by report |
1,313 |
1,166 |
$141K |
| 0012A |
|
134 |
100 |
$5K |
| 0011A |
|
129 |
101 |
$4K |
| 90686 |
|
2,819 |
2,395 |
$3K |
| 90677 |
|
266 |
256 |
$1K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
44,008 |
30,538 |
$1K |
| 0001A |
|
21 |
21 |
$884.94 |
| 90715 |
|
660 |
563 |
$535.24 |
| 90791 |
Psychiatric diagnostic evaluation |
2,172 |
1,719 |
$189.16 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
8,174 |
7,009 |
$64.00 |
| 90832 |
Psychotherapy, 30 minutes with patient |
6,447 |
4,393 |
$44.11 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
3,307 |
2,256 |
$36.00 |
| 81025 |
|
1,383 |
1,206 |
$27.32 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
842 |
778 |
$26.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
802 |
687 |
$20.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
779 |
695 |
$19.00 |
| 81002 |
|
812 |
656 |
$18.20 |
| 90656 |
|
63 |
59 |
$16.71 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
217 |
161 |
$13.00 |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
617 |
423 |
$13.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
1,082 |
922 |
$11.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
344 |
258 |
$10.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
480 |
417 |
$8.00 |
| 3725F |
|
16,101 |
14,169 |
$1.00 |
| 3078F |
|
15,703 |
13,659 |
$1.00 |
| 1160F |
|
19,096 |
16,071 |
$1.00 |
| 3077F |
|
2,348 |
2,091 |
$1.00 |
| 3008F |
|
22,520 |
19,261 |
$1.00 |
| 1036F |
|
18,184 |
15,515 |
$1.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
229 |
216 |
$0.00 |
| 3051F |
|
43 |
41 |
$0.00 |
| 90837 |
Psychotherapy, 53 minutes with patient |
1,345 |
700 |
$0.00 |
| D1120 |
Prophylaxis - child |
165 |
157 |
$0.00 |
| 0502F |
|
430 |
275 |
$0.00 |
| 99215 |
Prolong outpt/office vis |
529 |
513 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
41 |
41 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
117 |
107 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
169 |
157 |
$0.00 |
| 2028F |
|
24 |
24 |
$0.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
174 |
168 |
$0.00 |
| 90648 |
|
13 |
12 |
$0.00 |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
12 |
12 |
$0.00 |
| 99201 |
|
31 |
14 |
$0.00 |
| 93000 |
|
301 |
250 |
$0.00 |
| 3075F |
|
3,465 |
3,174 |
$0.00 |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
145 |
144 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
1,352 |
1,292 |
$0.00 |
| 3074F |
|
16,342 |
14,249 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
143 |
138 |
$0.00 |
| 90834 |
Psychotherapy, 45 minutes with patient |
2,048 |
922 |
$0.00 |
| 96127 |
|
8,836 |
7,991 |
$0.00 |
| 3080F |
|
793 |
732 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
69 |
54 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
164 |
156 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
164 |
161 |
$0.00 |
| 99383 |
|
14 |
12 |
$0.00 |
| G0467 |
Federally qualified health center (fqhc) visit, established patient; a medically-necessary, face-to-face encounter (one-on-one) between an established patient and a fqhc practitioner during which time one or more fqhc services are rendered and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving a fqhc visit |
13 |
13 |
$0.00 |
| 3079F |
|
5,460 |
4,945 |
$0.00 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
374 |
311 |
$0.00 |
| 3044F |
|
86 |
83 |
$0.00 |
| 99385 |
|
66 |
65 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
799 |
747 |
$0.00 |
| 1126F |
|
61 |
52 |
$0.00 |
| 87428 |
|
12 |
12 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
17 |
16 |
$0.00 |