| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T2023 |
Targeted case mgmt per month |
98,809 |
98,626 |
$20.46M |
| H2000 |
Comp multidisipln evaluation |
4,041 |
3,540 |
$1.27M |
| 8888888 |
|
1,393 |
368 |
$621K |
| H2016 |
Comp comm supp svc, per diem |
441 |
55 |
$419K |
| J0330 |
Succinycholine chloride inj |
3,206 |
1,048 |
$168K |
| T1001 |
Nursing assessment/evaluatn |
481 |
56 |
$66K |
| H2017 |
Psysoc rehab svc, per 15 min |
1,007 |
53 |
$47K |
| 90832 |
|
276 |
52 |
$31K |
| 99214 |
|
289 |
48 |
$25K |
| J8499 |
Oral prescrip drug non chemo |
3,201 |
595 |
$17K |
| 90791 |
|
13 |
13 |
$13K |
| H0038 |
Self-help/peer svc per 15min |
243 |
50 |
$8K |
| J3490 |
Drugs unclassified injection |
11,318 |
1,152 |
$5K |
| 90870 |
|
3,222 |
1,054 |
$4K |
| C9803 |
Hopd covid-19 spec collect |
295 |
137 |
$4K |
| G0463 |
Hospital outpt clinic visit |
44 |
42 |
$3K |
| H2014 |
Skills train and dev, 15 min |
14 |
12 |
$3K |
| 36415 |
|
172 |
152 |
$2K |
| 80305 |
|
54 |
50 |
$274.97 |
| U0002 |
Covid-19 lab test non-cdc |
12 |
12 |
$246.52 |
| J2405 |
Ondansetron hcl injection |
2,939 |
908 |
$210.24 |
| T1017 |
Targeted case management |
118 |
38 |
$155.00 |
| 80053 |
|
12 |
12 |
$35.96 |
| J3010 |
Fentanyl citrate injection |
1,136 |
422 |
$23.90 |
| J2704 |
Inj, propofol, 10 mg |
1,507 |
610 |
$16.74 |
| J1596 |
Inj, glycopyrrolate, 0.1 mg |
28 |
13 |
$4.96 |
| J1885 |
Ketorolac tromethamine inj |
485 |
146 |
$3.92 |
| S9485 |
Crisis intervention mental h |
129 |
117 |
$0.00 |
| U0003 |
Cov-19 amp prb hgh thruput |
252 |
121 |
$0.00 |
| U0005 |
Infec agen detec ampli probe |
193 |
95 |
$0.00 |
| G0378 |
Hospital observation per hr |
17 |
16 |
$0.00 |