| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 00003 |
|
55,180 |
42,582 |
$12.75M |
| T1015 |
Clinic service |
51,826 |
37,346 |
$6.41M |
| 90837 |
|
17,860 |
6,783 |
$469K |
| H2016 |
Comp comm supp svc, per diem |
526 |
526 |
$203K |
| 97810 |
|
12,794 |
4,848 |
$168K |
| 97811 |
|
12,730 |
4,851 |
$155K |
| G9012 |
Other specified case mgmt |
499 |
325 |
$132K |
| 90834 |
|
3,071 |
1,074 |
$75K |
| T2040 |
Financial mgt waiver/15min |
335 |
240 |
$74K |
| H0043 |
Supported housing, per diem |
95 |
95 |
$37K |
| 99213 |
|
31,236 |
23,561 |
$33K |
| G0442 |
Annual alcohol screen 15 min |
2,660 |
2,143 |
$29K |
| 99214 |
|
6,585 |
5,430 |
$11K |
| 80305 |
|
2,621 |
1,797 |
$11K |
| 90674 |
|
432 |
362 |
$9K |
| 0002A |
|
109 |
109 |
$7K |
| A0390 |
Advanced life support mileag |
30 |
29 |
$5K |
| 90832 |
|
360 |
179 |
$5K |
| 99202 |
|
394 |
275 |
$5K |
| 99212 |
|
5,835 |
4,291 |
$5K |
| 0001A |
|
71 |
71 |
$5K |
| 83036 |
|
731 |
578 |
$4K |
| 0003A |
|
62 |
62 |
$4K |
| 98941 |
|
345 |
174 |
$4K |
| 98940 |
|
322 |
160 |
$3K |
| A0120 |
Noner transport mini-bus |
102 |
91 |
$3K |
| 0012A |
|
40 |
40 |
$3K |
| 90686 |
|
106 |
106 |
$2K |
| D0150 |
|
18 |
18 |
$2K |
| 90715 |
|
95 |
73 |
$2K |
| 99203 |
|
114 |
91 |
$2K |
| 96372 |
|
97 |
81 |
$2K |
| 0011A |
|
23 |
23 |
$2K |
| 99283 |
|
2,191 |
1,986 |
$1K |
| 91322 |
|
25 |
25 |
$1K |
| H1001 |
Antepartum management |
16 |
12 |
$1K |
| 90791 |
|
59 |
38 |
$1K |
| 90471 |
|
921 |
795 |
$1K |
| 99204 |
|
117 |
92 |
$902.59 |
| 87635 |
|
16 |
14 |
$667.03 |
| Q3014 |
Telehealth facility fee |
14 |
14 |
$420.00 |
| G9920 |
Scrning perf and negative |
28 |
26 |
$406.00 |
| 82274 |
|
26 |
25 |
$367.64 |
| 99394 |
|
65 |
51 |
$328.98 |
| 81002 |
|
467 |
375 |
$309.45 |
| 90658 |
|
14 |
14 |
$249.76 |
| 81025 |
|
124 |
80 |
$210.00 |
| 92551 |
|
151 |
127 |
$193.80 |
| 87430 |
|
14 |
14 |
$114.52 |
| 82962 |
|
41 |
40 |
$82.00 |
| 90480 |
|
12 |
12 |
$80.00 |
| 90472 |
|
80 |
75 |
$22.30 |
| 85018 |
|
16 |
13 |
$2.07 |
| 99406 |
|
18 |
13 |
$0.05 |
| 99408 |
|
116 |
116 |
$0.00 |
| 4004F |
|
255 |
250 |
$0.00 |
| 99173 |
|
55 |
55 |
$0.00 |
| 97110 |
|
18 |
14 |
$0.00 |
| 99396 |
|
13 |
13 |
$0.00 |
| 99201 |
|
13 |
13 |
$0.00 |
| G9902 |
Pt scrn tbco and id as user |
400 |
396 |
$0.00 |
| G9903 |
Pt scrn tbco id as non user |
282 |
279 |
$0.00 |
| G0396 |
Alcohol/subs interv 15-30mn |
16 |
16 |
$0.00 |
| Z1034 |
|
50 |
39 |
$0.00 |
| G2025 |
Dis site tele svcs rhc/fqhc |
45 |
39 |
$0.00 |
| G0467 |
Fqhc visit, estab pt |
121 |
117 |
$0.00 |