| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
5,011 |
4,689 |
$871K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
257 |
256 |
$52K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
368 |
368 |
$28K |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
1,592 |
1,588 |
$14K |
| 90686 |
|
643 |
643 |
$10K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
317 |
317 |
$6K |
| 90715 |
|
96 |
96 |
$3K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
66 |
66 |
$2K |
| 99173 |
|
76 |
76 |
$2K |
| 90750 |
|
17 |
17 |
$2K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
114 |
114 |
$1K |
| 92551 |
|
76 |
76 |
$754.68 |
| 91313 |
|
18 |
18 |
$0.00 |