| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1041 |
Medicaid certified community behavioral health clinic services, per month |
708 |
677 |
$272K |
| T2022 |
Case management, per month |
644 |
631 |
$249K |
| T1007 |
Alcohol and/or substance abuse services, treatment plan development and/or modification |
708 |
677 |
$181K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,307 |
2,144 |
$158K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,438 |
2,216 |
$127K |
| 99408 |
|
649 |
635 |
$124K |
| H0047 |
Alcohol and/or other drug abuse services, not otherwise specified |
649 |
635 |
$100K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
392 |
361 |
$10K |
| 99215 |
Prolong outpt/office vis |
82 |
66 |
$8K |
| 90674 |
|
80 |
78 |
$992.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
29 |
29 |
$604.24 |
| 99406 |
|
63 |
59 |
$478.17 |
| 96127 |
|
152 |
144 |
$363.38 |
| 36415 |
Collection of venous blood by venipuncture |
260 |
240 |
$352.91 |
| 80061 |
Lipid panel |
26 |
25 |
$229.61 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
16 |
13 |
$69.62 |
| 36416 |
|
25 |
24 |
$31.50 |
| G0008 |
Administration of influenza virus vaccine |
44 |
44 |
$10.00 |
| 1160F |
|
2,297 |
1,665 |
$0.00 |
| 3077F |
|
425 |
294 |
$0.00 |
| 1159F |
|
1,780 |
1,291 |
$0.00 |
| 3725F |
|
94 |
74 |
$0.00 |
| 3078F |
|
1,071 |
796 |
$0.00 |
| 3075F |
|
395 |
287 |
$0.00 |
| 3079F |
|
497 |
381 |
$0.00 |
| 3074F |
|
975 |
763 |
$0.00 |
| 3008F |
|
2,058 |
1,517 |
$0.00 |
| 1036F |
|
213 |
158 |
$0.00 |
| 3080F |
|
179 |
152 |
$0.00 |
| 1034F |
|
19 |
19 |
$0.00 |