| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
30,563 |
21,231 |
$4.30M |
| T1040 |
Medicaid certified community behavioral health clinic services, per diem |
444 |
360 |
$30K |
| 90686 |
|
1,493 |
1,262 |
$2K |
| 0011A |
|
50 |
37 |
$2K |
| 0012A |
|
37 |
27 |
$2K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
16,093 |
11,707 |
$1K |
| 0001A |
|
21 |
21 |
$884.94 |
| 36415 |
Collection of venous blood by venipuncture |
290 |
224 |
$196.80 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,413 |
1,230 |
$95.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,589 |
1,211 |
$51.65 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
733 |
557 |
$39.14 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
950 |
816 |
$23.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
590 |
520 |
$20.00 |
| 90715 |
|
30 |
30 |
$16.71 |
| 96127 |
|
1,919 |
1,731 |
$6.00 |
| 81025 |
|
123 |
94 |
$5.16 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
387 |
338 |
$5.00 |
| 3079F |
|
1,287 |
1,189 |
$0.00 |
| 3075F |
|
755 |
708 |
$0.00 |
| 1036F |
|
5,998 |
5,149 |
$0.00 |
| 3074F |
|
5,973 |
5,281 |
$0.00 |
| 3008F |
|
7,673 |
6,749 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
72 |
71 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
922 |
751 |
$0.00 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
14 |
12 |
$0.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
12 |
12 |
$0.00 |
| 90677 |
|
30 |
27 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
16 |
14 |
$0.00 |
| 90832 |
Psychotherapy, 30 minutes with patient |
870 |
639 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
550 |
396 |
$0.00 |
| 3078F |
|
5,793 |
5,118 |
$0.00 |
| 0502F |
|
579 |
345 |
$0.00 |
| 90791 |
Psychiatric diagnostic evaluation |
171 |
136 |
$0.00 |
| 1160F |
|
6,507 |
5,598 |
$0.00 |
| 3725F |
|
5,375 |
4,704 |
$0.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
41 |
33 |
$0.00 |
| 3077F |
|
223 |
207 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
51 |
50 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
130 |
108 |
$0.00 |
| 81002 |
|
23 |
12 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
12 |
12 |
$0.00 |