| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1016 |
Case management |
31,033 |
8,659 |
$3.14M |
| H0039 |
Asser com tx face-face/15min |
47,121 |
1,692 |
$835K |
| T1017 |
Targeted case management |
7,005 |
4,962 |
$690K |
| S9484 |
Crisis intervention per hour |
11,258 |
2,806 |
$410K |
| H2017 |
Psysoc rehab svc, per 15 min |
1,894 |
187 |
$255K |
| A9999 |
Dme supply or accessory, nos |
1,109 |
1,084 |
$208K |
| T1999 |
Noc retail items andsupplies |
695 |
671 |
$123K |
| D1351 |
|
4,955 |
1,009 |
$83K |
| 90832 |
|
4,462 |
3,337 |
$81K |
| 99199 |
|
700 |
150 |
$66K |
| D1206 |
|
4,378 |
4,345 |
$55K |
| H2011 |
Crisis interven svc, 15 min |
634 |
551 |
$53K |
| D0191 |
|
4,431 |
4,398 |
$47K |
| S5190 |
Wellness assessment by nonph |
123 |
123 |
$37K |
| S0215 |
Nonemerg transp mileage |
661 |
284 |
$37K |
| 92507 |
|
550 |
364 |
$35K |
| S5170 |
Homedelivered prepared meal |
1,753 |
112 |
$25K |
| 90834 |
|
742 |
444 |
$24K |
| 97530 |
|
338 |
198 |
$22K |
| 99214 |
|
995 |
757 |
$19K |
| T2028 |
Special supply, nos waiver |
30 |
30 |
$12K |
| T2003 |
N-et; encounter/trip |
656 |
279 |
$9K |
| 90837 |
|
102 |
53 |
$7K |
| H1010 |
Nonmed family planning ed |
33 |
29 |
$2K |
| S4993 |
Contraceptive pills for bc |
39 |
34 |
$349.20 |
| 99213 |
|
12 |
12 |
$281.59 |
| 99211 |
|
38 |
37 |
$157.11 |
| A4267 |
Male condom |
13 |
13 |
$37.44 |
| 83655 |
|
12 |
12 |
$15.00 |
| 36416 |
|
12 |
12 |
$9.09 |