| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1017 |
Targeted case management, each 15 minutes |
7,349 |
3,728 |
$3.04M |
| T1015 |
Clinic visit/encounter, all-inclusive |
933 |
836 |
$105K |
| 0064A |
|
489 |
402 |
$10K |
| 0012A |
|
308 |
255 |
$5K |
| 0011A |
|
376 |
308 |
$4K |
| 0001A |
|
112 |
108 |
$4K |
| 0071A |
|
71 |
69 |
$3K |
| 0004A |
|
208 |
150 |
$3K |
| 0072A |
|
61 |
60 |
$2K |
| 90715 |
|
102 |
91 |
$2K |
| 90688 |
|
185 |
158 |
$2K |
| 0031A |
|
91 |
79 |
$2K |
| 0002A |
|
64 |
60 |
$2K |
| 91322 |
|
76 |
49 |
$2K |
| 0124A |
|
129 |
97 |
$1K |
| S4993 |
Contraceptive pills for birth control |
153 |
123 |
$1K |
| 0134A |
|
43 |
39 |
$1K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
85 |
80 |
$1K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
68 |
65 |
$986.60 |
| S4930 |
|
105 |
105 |
$965.43 |
| 90633 |
|
39 |
37 |
$812.52 |
| 90480 |
|
74 |
47 |
$600.00 |
| 90707 |
|
33 |
27 |
$570.96 |
| 0003A |
|
87 |
54 |
$440.00 |
| 81025 |
|
29 |
27 |
$156.80 |
| 87801 |
Infectious agent detection by nucleic acid; amplified probe, multiple organisms |
12 |
12 |
$149.05 |
| G0008 |
Administration of influenza virus vaccine |
24 |
14 |
$0.00 |
| 91301 |
|
59 |
59 |
$0.00 |