| Code | Description | Claims | Beneficiaries | Total Paid |
| T1015 |
Clinic service |
588,381 |
426,509 |
$107.63M |
| 00003 |
|
59,824 |
47,235 |
$13.85M |
| G9012 |
Other specified case mgmt |
18,887 |
15,952 |
$6.08M |
| 90834 |
|
128,931 |
105,952 |
$3.84M |
| 99213 |
|
942,832 |
879,409 |
$1.98M |
| 99214 |
|
556,986 |
528,798 |
$1.72M |
| 59425 |
|
61,707 |
55,165 |
$1.68M |
| 90791 |
|
21,577 |
21,378 |
$1.63M |
| G0467 |
Fqhc visit, estab pt |
41,024 |
30,971 |
$1.28M |
| G9008 |
Mccd,phys coor-care ovrsght |
14,934 |
10,982 |
$1.19M |
| 97139 |
|
91,238 |
45,524 |
$1.03M |
| 90832 |
|
34,353 |
30,326 |
$853K |
| 99404 |
|
45,264 |
44,352 |
$773K |
| 59409 |
|
1,222 |
1,222 |
$665K |
| 97161 |
|
17,264 |
16,838 |
$518K |
| 90792 |
|
9,590 |
9,554 |
$498K |
| 92004 |
|
26,534 |
26,451 |
$443K |
| 99212 |
|
189,900 |
180,810 |
$311K |
| 76805 |
|
6,493 |
6,241 |
$254K |
| J7307 |
Etonogestrel implant system |
588 |
588 |
$253K |
| 98941 |
|
26,122 |
19,610 |
$248K |
| 92014 |
|
14,969 |
14,904 |
$234K |
| H0043 |
Supported housing, per diem |
1,677 |
1,134 |
$213K |
| V2020 |
Vision svcs frames purchases |
23,386 |
23,282 |
$203K |
| 90837 |
|
3,248 |
2,790 |
$199K |
| 98940 |
|
18,616 |
13,943 |
$173K |
| 87491 |
|
55,193 |
54,811 |
$170K |
| 87591 |
|
55,270 |
54,891 |
$170K |
| 93000 |
|
17,064 |
16,866 |
$168K |
| 92340 |
|
16,369 |
16,301 |
$150K |
| 59514 |
|
295 |
293 |
$140K |
| 99460 |
|
2,696 |
2,671 |
$135K |
| 92015 |
|
40,208 |
40,071 |
$127K |
| 97803 |
|
86,151 |
84,777 |
$127K |
| 80061 |
|
165,092 |
164,564 |
$110K |
| 80053 |
|
181,610 |
180,419 |
$107K |
| G0470 |
Fqhc visit, mh estab pt |
3,184 |
2,593 |
$106K |
| 84443 |
|
122,072 |
121,486 |
$104K |
| 76801 |
|
3,753 |
3,653 |
$96K |
| 92012 |
|
7,010 |
6,604 |
$90K |
| 86480 |
|
25,010 |
24,901 |
$88K |
| 76815 |
|
3,854 |
2,783 |
$86K |
| 92250 |
|
29,002 |
28,924 |
$84K |
| 90677 |
|
4,938 |
4,928 |
$83K |
| 83036 |
|
157,093 |
156,597 |
$81K |
| 99395 |
|
20,728 |
20,555 |
$78K |
| 87389 |
|
53,066 |
52,887 |
$74K |
| 0004A |
|
1,089 |
1,074 |
$70K |
| 87428 |
|
28,588 |
28,208 |
$68K |
| 99238 |
|
1,729 |
1,665 |
$67K |
| H1001 |
Antepartum management |
5,547 |
4,970 |
$64K |
| 85025 |
|
150,477 |
148,898 |
$62K |
| 0124A |
|
1,086 |
1,001 |
$61K |
| 99401 |
|
21,943 |
20,712 |
$59K |
| 92341 |
|
4,577 |
4,556 |
$56K |
| 87536 |
|
5,040 |
5,005 |
$55K |
| 0002A |
|
818 |
788 |
$54K |
| 0001A |
|
808 |
788 |
$53K |
| 99462 |
|
1,985 |
1,612 |
$52K |
| 99392 |
|
36,521 |
36,295 |
$48K |
| H2016 |
Comp comm supp svc, per diem |
372 |
283 |
$47K |
| 97802 |
|
27,127 |
26,653 |
$45K |
| 90651 |
|
11,273 |
11,257 |
$44K |
| 11721 |
|
3,756 |
3,732 |
$43K |
| 81002 |
|
91,723 |
76,974 |
$42K |
| G2025 |
Dis site tele svcs rhc/fqhc |
4,485 |
3,883 |
$42K |
| H1003 |
Prenatal at risk education |
30,327 |
24,037 |
$39K |
| 99215 |
Prolong outpt/office vis |
1,644 |
1,577 |
$38K |
| J7298 |
Mirena, 52 mg |
79 |
77 |
$34K |
| 99393 |
|
27,665 |
27,632 |
$33K |
| 81025 |
|
83,587 |
81,365 |
$32K |
| 90739 |
|
4,562 |
4,543 |
$32K |
| 82274 |
|
18,925 |
18,854 |
$31K |
| 97810 |
|
2,317 |
1,813 |
$27K |
| 0071A |
|
457 |
454 |
$27K |
| 96110 |
|
15,057 |
14,989 |
$25K |
| 98960 |
|
22,568 |
21,592 |
$23K |
| 92557 |
|
1,966 |
1,965 |
$23K |
| 99396 |
|
13,279 |
13,168 |
$23K |
| 86704 |
|
20,574 |
20,505 |
$23K |
| 92551 |
|
69,903 |
69,589 |
$23K |
| 86706 |
|
24,324 |
24,241 |
$23K |
| 76817 |
|
566 |
545 |
$22K |
| 0072A |
|
330 |
330 |
$22K |
| 80307 |
|
4,741 |
4,579 |
$21K |
| 86803 |
|
26,724 |
26,639 |
$20K |
| J3490 |
Drugs unclassified injection |
810 |
801 |
$20K |
| 99391 |
|
18,670 |
18,193 |
$20K |
| 90697 |
|
3,722 |
3,649 |
$19K |
| 99394 |
|
16,367 |
16,346 |
$19K |
| 59430 |
|
1,190 |
1,178 |
$18K |
| 96156 |
|
15,209 |
13,116 |
$18K |
| 97162 |
|
12,379 |
11,968 |
$18K |
| 90847 |
|
1,898 |
1,082 |
$18K |
| 87086 |
|
35,514 |
34,669 |
$18K |
| G9920 |
Scrning perf and negative |
2,286 |
2,249 |
$15K |
| 90471 |
|
174,674 |
172,956 |
$15K |
| 0154A |
|
281 |
281 |
$14K |
| 90686 |
|
51,795 |
51,671 |
$14K |
| 99203 |
|
5,149 |
5,142 |
$14K |
| 86592 |
|
50,354 |
50,105 |
$13K |
| 87210 |
|
29,046 |
28,722 |
$12K |
| 90750 |
|
3,347 |
3,332 |
$12K |
| 82951 |
|
11,561 |
11,190 |
$12K |
| 90853 |
|
2,329 |
615 |
$12K |
| 99221 |
|
328 |
309 |
$11K |
| 90670 |
|
13,937 |
13,787 |
$11K |
| 92083 |
|
1,284 |
1,267 |
$11K |
| 99402 |
|
5,949 |
5,857 |
$11K |
| 99231 |
|
380 |
297 |
$11K |
| 97039 |
|
2,492 |
989 |
$10K |
| 90661 |
|
4,736 |
4,734 |
$10K |
| 90472 |
|
17,208 |
17,180 |
$10K |
| 90710 |
|
3,580 |
3,575 |
$10K |
| 80048 |
|
16,435 |
16,179 |
$9K |
| 76816 |
|
651 |
649 |
$9K |
| 0081A |
|
184 |
183 |
$9K |
| 83550 |
|
10,502 |
10,450 |
$8K |
| 84153 |
|
3,651 |
3,643 |
$8K |
| S9445 |
Pt education noc individ |
60,598 |
56,335 |
$8K |
| 82043 |
|
19,042 |
18,965 |
$8K |
| 87522 |
Neg quan hep c or qual rna |
2,242 |
2,199 |
$8K |
| 82570 |
|
18,391 |
18,291 |
$8K |
| 90715 |
|
10,544 |
10,526 |
$8K |
| 83540 |
|
11,658 |
11,603 |
$7K |
| 92507 |
|
1,434 |
628 |
$7K |
| 92550 |
|
1,773 |
1,771 |
$7K |
| 0003A |
|
109 |
98 |
$7K |
| 11981 |
|
122 |
121 |
$7K |
| 81015 |
|
32,699 |
31,874 |
$6K |
| 90633 |
|
9,447 |
9,329 |
$6K |
| 90656 |
|
3,577 |
3,577 |
$6K |
| 96372 |
|
7,139 |
6,830 |
$6K |
| 84439 |
|
7,279 |
7,157 |
$6K |
| 87070 |
|
16,858 |
16,725 |
$5K |
| 76700 |
|
127 |
127 |
$5K |
| S9452 |
Nutrition class |
1,428 |
1,268 |
$5K |
| U0003 |
Cov-19 amp prb hgh thruput |
38,670 |
37,896 |
$5K |
| 99222 |
|
72 |
69 |
$5K |
| 92567 |
|
2,385 |
2,382 |
$5K |
| 82728 |
|
11,512 |
11,460 |
$5K |
| 59025 |
|
1,862 |
1,311 |
$5K |
| 90698 |
|
5,597 |
5,584 |
$5K |
| 90756 |
|
20,122 |
20,087 |
$5K |
| 90619 |
|
2,431 |
2,429 |
$5K |
| 85018 |
|
49,519 |
49,110 |
$4K |
| 98942 |
|
576 |
461 |
$4K |
| 82306 |
|
414 |
411 |
$4K |
| 90674 |
|
10,700 |
10,674 |
$4K |
| 0073A |
|
77 |
77 |
$4K |
| T2041 |
Support broker waiver/15 min |
13 |
13 |
$4K |
| 92134 |
|
969 |
965 |
$4K |
| 87340 |
|
6,127 |
6,111 |
$4K |
| 84460 |
|
14,099 |
14,028 |
$4K |
| 92133 |
|
971 |
967 |
$4K |
| 86140 |
|
6,314 |
6,266 |
$4K |
| 84450 |
|
14,096 |
14,025 |
$3K |
| 90833 |
|
167 |
158 |
$3K |
| 86708 |
|
2,002 |
1,999 |
$3K |
| 87880 |
|
20,010 |
19,827 |
$3K |
| 96127 |
|
32,509 |
29,499 |
$3K |
| 92587 |
|
2,158 |
2,155 |
$3K |
| 85651 |
|
9,456 |
9,401 |
$3K |
| 11055 |
|
290 |
281 |
$2K |
| 0082A |
|
59 |
56 |
$2K |
| 97110 |
|
9,338 |
5,388 |
$2K |
| 92002 |
|
198 |
198 |
$2K |
| 90716 |
|
1,920 |
1,909 |
$2K |
| 99459 |
|
1,263 |
1,260 |
$2K |
| 90680 |
|
5,064 |
5,031 |
$2K |
| 97811 |
|
340 |
279 |
$2K |
| H2000 |
Comp multidisipln evaluation |
311 |
280 |
$2K |
| 0173A |
|
56 |
56 |
$2K |
| 83735 |
|
2,112 |
2,081 |
$2K |
| 58300 |
|
201 |
201 |
$2K |
| 90480 |
|
830 |
827 |
$2K |
| 87081 |
|
4,448 |
4,421 |
$2K |
| 81003 |
|
26,420 |
25,985 |
$2K |
| 90381 |
|
177 |
177 |
$2K |
| J1050 |
Medroxyprogesterone acetate |
1,931 |
1,927 |
$2K |
| 90734 |
|
3,506 |
3,506 |
$2K |
| 83970 |
|
39 |
39 |
$2K |
| 97001 |
|
46 |
43 |
$2K |
| 83690 |
|
1,825 |
1,819 |
$1K |
| 87635 |
|
917 |
889 |
$1K |
| 87811 |
|
5,968 |
5,897 |
$1K |
| 31575 |
|
144 |
144 |
$1K |
| 90632 |
|
340 |
340 |
$1K |
| 96112 |
|
89 |
81 |
$1K |
| 11982 |
|
24 |
24 |
$1K |
| 90681 |
|
634 |
633 |
$1K |
| 81001 |
|
8,207 |
7,953 |
$1K |
| 90696 |
|
2,303 |
2,298 |
$1K |
| 99412 |
|
79 |
61 |
$1K |
| 90636 |
|
251 |
251 |
$1K |
| 84702 |
|
709 |
546 |
$1K |
| 84550 |
|
1,962 |
1,951 |
$1K |
| 99204 |
|
1,010 |
1,010 |
$973.02 |
| 86593 |
|
1,155 |
1,107 |
$920.52 |
| 80076 |
|
1,811 |
1,795 |
$903.98 |
| 99234 |
|
12 |
12 |
$896.40 |
| 97140 |
|
193 |
121 |
$885.34 |
| H1000 |
Prenatal care atrisk assessm |
57 |
56 |
$880.10 |
| 85027 |
|
1,749 |
1,747 |
$804.46 |
| 93005 |
|
60 |
60 |
$793.05 |
| 99188 |
|
439 |
439 |
$738.00 |
| 80074 |
|
108 |
108 |
$719.29 |
| 90707 |
|
1,423 |
1,419 |
$703.85 |
| 20610 |
|
1,187 |
1,034 |
$693.91 |
| 91321 |
|
376 |
376 |
$685.80 |
| 83921 |
|
32 |
32 |
$678.72 |
| 99202 |
|
2,454 |
2,450 |
$652.75 |
| 82947 |
|
10,674 |
10,502 |
$635.95 |
| 86769 |
|
344 |
343 |
$631.95 |
| 80081 |
|
334 |
333 |
$616.79 |
| 90688 |
|
2,427 |
2,426 |
$580.00 |
| 99283 |
|
13 |
13 |
$579.80 |
| 99201 |
|
683 |
681 |
$572.50 |
| 82607 |
|
172 |
171 |
$571.64 |
| 90685 |
|
772 |
769 |
$560.00 |
| 84156 |
|
777 |
760 |
$554.27 |
| 85610 |
|
4,201 |
3,832 |
$550.08 |
| 97164 |
|
60 |
60 |
$538.23 |
| 90700 |
|
2,331 |
2,327 |
$515.57 |
| 11056 |
|
69 |
68 |
$512.75 |
| 99000 |
|
70,213 |
67,353 |
$488.51 |
| 90713 |
|
535 |
532 |
$474.60 |
| 90744 |
|
3,661 |
3,653 |
$446.66 |
| 90746 |
|
784 |
782 |
$439.89 |
| 98926 |
|
33 |
29 |
$395.40 |
| 82565 |
|
855 |
846 |
$385.63 |
| 87798 |
|
3,289 |
3,253 |
$361.20 |
| G0466 |
Fqhc visit new patient |
49 |
49 |
$334.50 |
| 90694 |
|
379 |
377 |
$323.91 |
| 90785 |
|
730 |
721 |
$316.74 |
| 96151 |
|
1,319 |
1,257 |
$302.76 |
| G0108 |
Diab manage trn per indiv |
2,862 |
2,812 |
$297.46 |
| 92100 |
|
66 |
66 |
$289.33 |
| 82747 |
|
16 |
16 |
$282.40 |
| 99385 |
|
134 |
134 |
$276.00 |
| 85014 |
|
1,268 |
1,259 |
$269.67 |
| 99453 |
|
15 |
13 |
$266.55 |
| 92132 |
|
25 |
25 |
$247.99 |
| 11730 |
|
92 |
90 |
$224.14 |
| 90648 |
|
1,468 |
1,466 |
$212.50 |
| L3260 |
Ambulatory surgical boot eac |
67 |
65 |
$199.65 |
| 90714 |
|
253 |
253 |
$199.31 |
| 83721 |
|
177 |
177 |
$194.52 |
| 99211 |
|
171 |
164 |
$192.00 |
| 82310 |
|
217 |
211 |
$186.87 |
| 87209 |
|
13 |
13 |
$163.35 |
| 80354 |
|
2,649 |
2,589 |
$161.61 |
| 86701 |
|
152 |
151 |
$151.09 |
| 87804 |
|
4,837 |
4,810 |
$150.36 |
| 90461 |
|
19,824 |
19,793 |
$146.34 |
| 82248 |
|
564 |
446 |
$146.14 |
| 84132 |
|
234 |
217 |
$142.96 |
| 76514 |
|
33 |
33 |
$137.48 |
| 82247 |
|
691 |
539 |
$135.90 |
| 99406 |
|
2,687 |
2,604 |
$117.84 |
| 97010 |
|
109 |
79 |
$115.68 |
| J0696 |
Ceftriaxone sodium injection |
1,296 |
1,262 |
$112.10 |
| 90653 |
|
193 |
193 |
$106.00 |
| 82270 |
|
365 |
365 |
$105.12 |
| 90460 |
|
41,383 |
41,232 |
$104.72 |
| 96160 |
|
41,011 |
40,155 |
$103.05 |
| 99070 |
|
722 |
721 |
$102.96 |
| J3301 |
Triamcinolone acet inj nos |
1,141 |
1,099 |
$102.85 |
| G0071 |
Comm svcs by rhc/fqhc 5 min |
18 |
16 |
$102.84 |
| 99417 |
Prolong home eval add 15m |
27 |
19 |
$85.14 |
| 84100 |
|
68 |
67 |
$73.48 |
| 80055 |
|
141 |
141 |
$70.94 |
| 96150 |
|
1,850 |
1,788 |
$67.29 |
| 96113 |
|
26 |
26 |
$63.22 |
| 20611 |
|
70 |
53 |
$55.52 |
| 86580 |
|
3,802 |
3,727 |
$50.35 |
| 87329 |
|
14 |
14 |
$49.68 |
| G0109 |
Diab manage trn ind/group |
80 |
64 |
$49.04 |
| 86787 |
|
47 |
47 |
$48.84 |
| G0447 |
Behavior counsel obesity 15m |
65 |
63 |
$44.52 |
| 91200 |
|
332 |
328 |
$41.83 |
| 69209 |
|
1,001 |
975 |
$41.37 |
| 82746 |
|
42 |
42 |
$40.04 |
| 92020 |
|
12 |
12 |
$38.42 |
| A9300 |
Exercise equipment |
271 |
243 |
$37.50 |
| 36415 |
|
10,336 |
9,849 |
$31.50 |
| 94760 |
|
22,365 |
21,375 |
$29.33 |
| 99173 |
|
51,144 |
51,034 |
$25.44 |
| G0511 |
Ccm/bhi by rhc/fqhc 20min mo |
29 |
29 |
$24.40 |
| H0001 |
Alcohol and/or drug assess |
3,431 |
1,998 |
$22.50 |
| 86308 |
|
26 |
26 |
$22.41 |
| J1885 |
Ketorolac tromethamine inj |
1,299 |
1,269 |
$18.50 |
| 96152 |
|
166 |
162 |
$16.82 |
| A4267 |
Male condom |
296 |
296 |
$16.20 |
| S5199 |
Personal care item nos each |
12 |
12 |
$3.20 |
| 85007 |
|
894 |
888 |
$2.71 |
| 94640 |
|
375 |
348 |
$1.09 |
| 3079F |
|
66,635 |
65,078 |
$0.00 |
| 3074F |
|
306,413 |
296,485 |
$0.00 |
| 3008F |
|
49,084 |
47,722 |
$0.00 |
| G8510 |
Scr dep neg, no plan reqd |
47,138 |
46,834 |
$0.00 |
| 3075F |
|
21,349 |
21,006 |
$0.00 |
| Z6406 |
|
4,254 |
3,856 |
$0.00 |
| 3044F |
|
4,838 |
4,833 |
$0.00 |
| Z1034 |
|
25,010 |
18,287 |
$0.00 |
| Z6410 |
|
2,749 |
2,667 |
$0.00 |
| 99381 |
|
2,662 |
2,641 |
$0.00 |
| 36416 |
|
1,559 |
1,549 |
$0.00 |
| 2023F |
|
2,684 |
2,681 |
$0.00 |
| 90732 |
|
247 |
246 |
$0.00 |
| Z1038 |
|
928 |
919 |
$0.00 |
| 96161 |
|
210 |
210 |
$0.00 |
| Z6402 |
|
2,154 |
2,148 |
$0.00 |
| Z6204 |
|
4,792 |
4,458 |
$0.00 |
| 99243 |
|
13 |
13 |
$0.00 |
| X3924 |
|
626 |
564 |
$0.00 |
| 3080F |
|
973 |
935 |
$0.00 |
| 0011A |
|
464 |
464 |
$0.00 |
| 99383 |
|
105 |
105 |
$0.00 |
| X4102 |
|
110 |
109 |
$0.00 |
| X4304 |
|
5,536 |
2,424 |
$0.00 |
| Z1032 |
|
2,144 |
2,135 |
$0.00 |
| 97804 |
|
72 |
53 |
$0.00 |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
322 |
322 |
$0.00 |
| A4627 |
Spacer bag/reservoir |
13 |
13 |
$0.00 |
| X4100 |
|
113 |
112 |
$0.00 |
| 99024 |
|
105 |
83 |
$0.00 |
| 91307 |
|
50 |
50 |
$0.00 |
| 91301 |
|
254 |
254 |
$0.00 |
| Z6404 |
|
189 |
183 |
$0.00 |
| J7611 |
Albuterol non-comp con |
290 |
267 |
$0.00 |
| G0439 |
Ppps, subseq visit |
43 |
43 |
$0.00 |
| 58100 |
|
138 |
137 |
$0.00 |
| 3072F |
|
207 |
207 |
$0.00 |
| 0012A |
|
76 |
76 |
$0.00 |
| 1038F |
|
13 |
13 |
$0.00 |
| 99384 |
|
74 |
74 |
$0.00 |
| 57454 |
|
25 |
25 |
$0.00 |
| J1100 |
Dexamethasone sodium phos |
88 |
85 |
$0.00 |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
38 |
38 |
$0.00 |
| 86850 |
|
19 |
19 |
$0.00 |
| V2100 |
Lens spher single plano 4.00 |
75 |
75 |
$0.00 |
| J7644 |
Ipratropium bromide non-comp |
85 |
81 |
$0.00 |
| 87088 |
|
77 |
75 |
$0.00 |
| 31231 |
|
27 |
27 |
$0.00 |
| 91317 |
|
51 |
51 |
$0.00 |
| L1810 |
Ko elastic with joints |
13 |
13 |
$0.00 |
| 0031A |
|
72 |
72 |
$0.00 |
| 90474 |
|
54 |
54 |
$0.00 |
| J7613 |
Albuterol non-comp unit |
45 |
44 |
$0.00 |
| 80050 |
|
142 |
142 |
$0.00 |
| 93306 |
|
13 |
13 |
$0.00 |
| 58301 |
|
26 |
26 |
$0.00 |
| S8101 |
Spacer with mask |
12 |
12 |
$0.00 |
| 76811 |
|
49 |
45 |
$0.00 |
| 83001 |
|
13 |
13 |
$0.00 |
| 91315 |
|
13 |
13 |
$0.00 |
| 91303 |
|
25 |
25 |
$0.00 |
| 99441 |
|
16 |
16 |
$0.00 |
| 2022F |
|
915 |
914 |
$0.00 |
| 3078F |
|
280,159 |
271,305 |
$0.00 |
| X3904 |
|
3,299 |
1,773 |
$0.00 |
| Z6304 |
|
3,533 |
3,361 |
$0.00 |
| 3077F |
|
7,032 |
6,782 |
$0.00 |
| 86677 |
|
148 |
148 |
$0.00 |
| Z6400 |
|
10,912 |
9,005 |
$0.00 |
| Z6300 |
|
2,218 |
2,216 |
$0.00 |
| Z6308 |
|
775 |
713 |
$0.00 |
| 2028F |
|
2,100 |
2,061 |
$0.00 |
| T1013 |
Sign lang/oral interpreter |
6,907 |
6,428 |
$0.00 |
| 92582 |
|
977 |
977 |
$0.00 |
| 91312 |
|
701 |
701 |
$0.00 |
| 92553 |
|
2,732 |
2,725 |
$0.00 |
| 87186 |
|
77 |
75 |
$0.00 |
| 97530 |
|
721 |
373 |
$0.00 |
| Q0144 |
Azithromycin dihydrate, oral |
210 |
208 |
$0.00 |
| 90658 |
|
83 |
83 |
$0.00 |
| Z6500 |
|
88 |
88 |
$0.00 |
| Z6414 |
|
1,527 |
1,315 |
$0.00 |
| 90380 |
|
183 |
183 |
$0.00 |
| 91308 |
|
104 |
104 |
$0.00 |
| Z6200 |
|
1,695 |
1,695 |
$0.00 |
| H0005 |
Alcohol and/or drug services |
450 |
170 |
$0.00 |
| J0171 |
Adrenalin epinephrine inject |
137 |
137 |
$0.00 |
| Z6208 |
|
1,034 |
957 |
$0.00 |
| X4110 |
|
4,557 |
2,142 |
$0.00 |
| 92555 |
|
566 |
566 |
$0.00 |
| 10060 |
|
195 |
185 |
$0.00 |
| 84403 |
|
84 |
83 |
$0.00 |
| 90611 |
|
147 |
146 |
$0.00 |
| 96159 |
|
153 |
128 |
$0.00 |
| X4301 |
|
313 |
313 |
$0.00 |
| G8431 |
Pos clin depres scrn f/u doc |
163 |
161 |
$0.00 |
| 92579 |
|
919 |
918 |
$0.00 |
| 82465 |
|
173 |
173 |
$0.00 |
| 0110T |
|
201 |
198 |
$0.00 |
| 90630 |
|
370 |
368 |
$0.00 |
| 91313 |
|
99 |
99 |
$0.00 |
| 90473 |
|
240 |
240 |
$0.00 |
| 76981 |
|
15 |
13 |
$0.00 |
| Z6302 |
|
102 |
102 |
$0.00 |
| 83718 |
|
159 |
159 |
$0.00 |
| 84146 |
|
40 |
40 |
$0.00 |
| 96116 |
|
15 |
14 |
$0.00 |
| 90687 |
|
94 |
94 |
$0.00 |
| 99382 |
|
38 |
38 |
$0.00 |
| 91300 |
|
12 |
12 |
$0.00 |
| 91322 |
|
139 |
139 |
$0.00 |
| 92552 |
|
56 |
56 |
$0.00 |
| 96158 |
|
44 |
44 |
$0.00 |
| 96167 |
|
31 |
27 |
$0.00 |
| 0013A |
|
14 |
14 |
$0.00 |
| L1812 |
Ko elastic w/joints pre ots |
12 |
12 |
$0.00 |
| L1836 |
Ko rigid w/o joints pre ots |
12 |
12 |
$0.00 |
| Z6202 |
|
42 |
41 |
$0.00 |
| 99411 |
|
13 |
13 |
$0.00 |
| 94060 |
|
13 |
12 |
$0.00 |
| 80305 |
|
12 |
12 |
$0.00 |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
12 |
12 |
$0.00 |
| J7510 |
Prednisolone oral per 5 mg |
18 |
18 |
$0.00 |
| J7614 |
Levalbuterol non-comp unit |
21 |
18 |
$0.00 |