| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1502 |
Medication admin visit |
2,662 |
1,415 |
$228K |
| 0013A |
|
636 |
630 |
$7K |
| 0134A |
|
166 |
132 |
$3K |
| M0201 |
Pne flu hepb cov home admin |
170 |
144 |
$3K |
| 0012A |
|
209 |
198 |
$3K |
| 0011A |
|
172 |
167 |
$2K |
| 90471 |
|
135 |
131 |
$1K |
| 90688 |
|
67 |
67 |
$1K |
| 0064A |
|
46 |
46 |
$909.32 |
| 0124A |
|
39 |
38 |
$615.30 |
| A0429 |
Bls-emergency |
189 |
177 |
$505.00 |
| 0031A |
|
32 |
30 |
$462.17 |
| 90686 |
|
16 |
16 |
$335.25 |
| U0003 |
Cov-19 amp prb hgh thruput |
1,556 |
953 |
$240.00 |
| 0034A |
|
15 |
15 |
$189.88 |
| 0003A |
|
20 |
20 |
$160.00 |
| 87426 |
|
2,388 |
887 |
$104.82 |
| U0005 |
Infec agen detec ampli probe |
1,546 |
936 |
$75.00 |
| 99213 |
|
458 |
414 |
$70.00 |
| 99214 |
|
463 |
423 |
$54.42 |
| 0002A |
|
20 |
20 |
$40.00 |
| 83036 |
|
71 |
71 |
$7.00 |
| K1034 |
Covid test self-admn/collect |
197 |
184 |
$0.00 |
| 98941 |
|
131 |
56 |
$0.00 |
| 87636 |
|
317 |
196 |
$0.00 |
| 87635 |
|
423 |
378 |
$0.00 |
| A9276 |
Disposable sensor, cgm sys |
41 |
40 |
$0.00 |
| 99439 |
|
53 |
53 |
$0.00 |
| 97140 |
|
215 |
56 |
$0.00 |
| 99232 |
|
43 |
12 |
$0.00 |
| 98943 |
|
33 |
12 |
$0.00 |
| 3074F |
|
78 |
65 |
$0.00 |
| 71045 |
|
153 |
146 |
$0.00 |
| G0008 |
Admin influenza virus vac |
42 |
41 |
$0.00 |
| A0427 |
Als1-emergency |
113 |
101 |
$0.00 |
| J0401 |
Inj, abilify maintena, 1 mg |
601 |
278 |
$0.00 |
| 3008F |
|
51 |
47 |
$0.00 |
| 3044F |
|
30 |
30 |
$0.00 |
| 99000 |
|
105 |
86 |
$0.00 |
| G2024 |
Spec coll snf/lab covid-19 |
23 |
22 |
$0.00 |
| 98967 |
|
13 |
12 |
$0.00 |
| G9012 |
Other specified case mgmt |
197 |
197 |
$0.00 |
| 0001A |
|
14 |
14 |
$0.00 |
| G2023 |
Specimen collect covid-19 |
1,604 |
865 |
$0.00 |
| J1944 |
Aripiprazole lauroxil 1 mg |
234 |
118 |
$0.00 |
| 99211 |
|
496 |
204 |
$0.00 |
| 97110 |
|
258 |
77 |
$0.00 |
| S9430 |
Pharmacy comp/disp serv |
145 |
95 |
$0.00 |
| J2426 |
Inj, invega sustenna, 1 mg |
1,411 |
673 |
$0.00 |
| S9083 |
Urgent care center global |
86 |
85 |
$0.00 |
| 97530 |
|
36 |
12 |
$0.00 |
| 99203 |
|
81 |
77 |
$0.00 |
| 87811 |
|
499 |
206 |
$0.00 |
| 98968 |
|
238 |
135 |
$0.00 |
| 70450 |
|
17 |
17 |
$0.00 |
| A0425 |
Ground mileage |
204 |
190 |
$0.00 |
| 99204 |
|
80 |
80 |
$0.00 |
| A4927 |
Non-sterile gloves |
158 |
135 |
$0.00 |
| J1631 |
Haloperidol decanoate inj |
234 |
79 |
$0.00 |
| 99490 |
Ccm add 20min |
140 |
140 |
$0.00 |
| 99212 |
|
30 |
27 |
$0.00 |
| U0004 |
Cov-19 test non-cdc hgh thru |
129 |
117 |
$0.00 |
| 99223 |
Prolong inpt eval add15 m |
17 |
13 |
$0.00 |
| 3078F |
|
41 |
33 |
$0.00 |
| 74177 |
|
13 |
13 |
$0.00 |
| 73630 |
|
14 |
13 |
$0.00 |
| 90837 |
|
81 |
37 |
$0.00 |
| T1015 |
Clinic service |
61 |
53 |
$0.00 |
| 3046F |
|
12 |
12 |
$0.00 |