| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| H2017 |
Psysoc rehab svc, per 15 min |
142,952 |
11,563 |
$15.02M |
| T1016 |
Case management |
42,667 |
12,377 |
$2.91M |
| 99199 |
|
35,703 |
7,615 |
$1.38M |
| T1017 |
Targeted case management |
3,729 |
3,222 |
$273K |
| 97530 |
|
797 |
351 |
$59K |
| T1999 |
Noc retail items andsupplies |
418 |
336 |
$55K |
| D1351 |
|
2,540 |
585 |
$40K |
| 92507 |
|
574 |
323 |
$34K |
| D1206 |
|
2,870 |
2,836 |
$34K |
| 99213 |
|
1,453 |
1,300 |
$26K |
| H1003 |
Prenatal at risk education |
702 |
540 |
$22K |
| D0191 |
|
2,102 |
2,075 |
$21K |
| S9484 |
Crisis intervention per hour |
253 |
201 |
$16K |
| A9999 |
Dme supply or accessory, nos |
123 |
105 |
$13K |
| 99214 |
|
300 |
270 |
$8K |
| H1004 |
Follow up home visit/prental |
209 |
162 |
$6K |
| H2011 |
Crisis interven svc, 15 min |
86 |
76 |
$5K |
| 99211 |
|
551 |
487 |
$5K |
| S5161 |
Emer rspns sys serv permonth |
226 |
226 |
$3K |
| 90791 |
|
100 |
93 |
$3K |
| 83655 |
|
289 |
255 |
$3K |
| 96372 |
|
1,280 |
913 |
$3K |
| Q3014 |
Telehealth facility fee |
529 |
424 |
$2K |
| D1120 |
|
34 |
33 |
$606.96 |
| 0002A |
|
77 |
68 |
$591.02 |
| D0120 |
|
41 |
41 |
$583.04 |
| 36416 |
|
279 |
253 |
$575.70 |
| 99215 |
Prolong outpt/office vis |
29 |
24 |
$546.64 |
| 0001A |
|
93 |
80 |
$398.36 |
| H0030 |
Alcohol and/or drug hotline |
13 |
13 |
$355.90 |
| 90658 |
|
13 |
13 |
$36.41 |