| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic service |
145,171 |
124,013 |
$18.79M |
| 00003 |
|
24,344 |
18,906 |
$5.33M |
| G9012 |
Other specified case mgmt |
3,347 |
1,684 |
$546K |
| H1001 |
Antepartum management |
4,747 |
3,782 |
$323K |
| 59425 |
|
2,926 |
2,203 |
$230K |
| 90832 |
|
13,157 |
6,271 |
$202K |
| 99213 |
|
95,846 |
63,375 |
$162K |
| 99214 |
|
26,248 |
17,974 |
$81K |
| G0467 |
Fqhc visit, estab pt |
7,385 |
6,803 |
$79K |
| G0442 |
Annual alcohol screen 15 min |
10,244 |
7,082 |
$76K |
| 90686 |
|
5,501 |
4,118 |
$45K |
| 90834 |
|
1,282 |
728 |
$34K |
| 90688 |
|
1,836 |
1,430 |
$29K |
| 97803 |
|
1,899 |
1,655 |
$27K |
| S9445 |
Pt education noc individ |
1,049 |
795 |
$19K |
| 99391 |
|
2,786 |
1,994 |
$16K |
| H1002 |
Carecoordination prenatal |
122 |
118 |
$15K |
| 90670 |
|
1,753 |
1,286 |
$15K |
| S9452 |
Nutrition class |
1,125 |
836 |
$14K |
| 96156 |
|
1,133 |
1,013 |
$14K |
| 0004A |
|
203 |
202 |
$13K |
| G8510 |
Scr dep neg, no plan reqd |
3,153 |
2,118 |
$13K |
| 99212 |
|
6,881 |
4,448 |
$12K |
| 90715 |
|
821 |
640 |
$12K |
| H1003 |
Prenatal at risk education |
790 |
697 |
$10K |
| J3490 |
Drugs unclassified injection |
234 |
207 |
$10K |
| 97802 |
|
86 |
81 |
$8K |
| 99392 |
|
3,996 |
2,625 |
$8K |
| G2023 |
Specimen collect covid-19 |
363 |
309 |
$7K |
| 0064A |
|
104 |
104 |
$7K |
| 99401 |
|
510 |
496 |
$6K |
| 90791 |
|
124 |
77 |
$5K |
| 90647 |
|
1,095 |
815 |
$5K |
| 90633 |
|
832 |
635 |
$5K |
| 0124A |
|
74 |
74 |
$5K |
| 90723 |
|
968 |
701 |
$4K |
| 99393 |
|
2,897 |
1,867 |
$4K |
| 0071A |
|
57 |
56 |
$4K |
| 0002A |
|
57 |
57 |
$4K |
| 92551 |
|
8,662 |
5,624 |
$3K |
| 99211 |
|
2,302 |
1,776 |
$3K |
| 99394 |
|
1,481 |
966 |
$3K |
| 90651 |
|
493 |
378 |
$3K |
| 97810 |
|
327 |
146 |
$3K |
| 0001A |
|
44 |
44 |
$3K |
| 97811 |
|
308 |
144 |
$3K |
| 99204 |
|
88 |
70 |
$2K |
| 76815 |
|
95 |
53 |
$2K |
| 0072A |
|
33 |
33 |
$2K |
| 90837 |
|
273 |
186 |
$2K |
| 96110 |
|
82 |
54 |
$2K |
| 0012A |
|
27 |
27 |
$2K |
| 90656 |
|
258 |
179 |
$2K |
| 99283 |
|
12,103 |
10,947 |
$2K |
| 81025 |
|
879 |
652 |
$2K |
| 90734 |
|
246 |
195 |
$1K |
| 0011A |
|
25 |
23 |
$1K |
| 96151 |
|
106 |
95 |
$1K |
| G2025 |
Dis site tele svcs rhc/fqhc |
2,014 |
1,826 |
$1K |
| 90681 |
|
276 |
194 |
$936.00 |
| 99203 |
|
68 |
46 |
$867.47 |
| 90716 |
|
77 |
67 |
$821.45 |
| 76816 |
|
47 |
25 |
$673.92 |
| G0108 |
Diab manage trn per indiv |
13 |
13 |
$594.62 |
| 99381 |
|
50 |
35 |
$557.04 |
| 90671 |
|
124 |
96 |
$540.00 |
| 90662 |
|
33 |
27 |
$474.06 |
| 90680 |
|
76 |
66 |
$432.00 |
| H0049 |
Alcohol/drug screening |
14 |
14 |
$336.00 |
| 85018 |
|
2,663 |
2,509 |
$278.40 |
| 83036 |
|
936 |
899 |
$277.00 |
| 90700 |
|
49 |
29 |
$225.00 |
| 96150 |
|
13 |
13 |
$210.37 |
| 81002 |
|
370 |
293 |
$195.65 |
| 90710 |
|
33 |
24 |
$153.00 |
| 90707 |
|
28 |
25 |
$153.00 |
| 99406 |
|
14 |
14 |
$149.24 |
| 97026 |
|
61 |
30 |
$140.71 |
| 86703 |
|
14 |
12 |
$131.56 |
| 90696 |
|
28 |
25 |
$126.00 |
| A4267 |
Male condom |
12 |
12 |
$96.00 |
| 90744 |
|
14 |
12 |
$72.00 |
| 90471 |
|
105 |
94 |
$53.07 |
| 99000 |
|
22 |
13 |
$40.50 |
| S5199 |
Personal care item nos each |
12 |
12 |
$36.00 |
| 88720 |
|
62 |
51 |
$12.90 |
| 86580 |
|
76 |
71 |
$10.08 |
| 82947 |
|
35 |
33 |
$6.60 |
| Z6208 |
|
1,059 |
830 |
$0.00 |
| Z6304 |
|
1,063 |
994 |
$0.00 |
| Z6414 |
|
44 |
43 |
$0.00 |
| Z6400 |
|
749 |
741 |
$0.00 |
| Z6500 |
|
470 |
470 |
$0.00 |
| 87804 |
|
84 |
84 |
$0.00 |
| Q2038 |
Fluzone vacc, 3 yrs & >, im |
159 |
159 |
$0.00 |
| Z6308 |
|
56 |
56 |
$0.00 |
| Z6302 |
|
27 |
27 |
$0.00 |
| Z6200 |
|
43 |
43 |
$0.00 |
| 87880 |
|
12 |
12 |
$0.00 |
| Z6300 |
|
43 |
43 |
$0.00 |
| 99173 |
|
16 |
16 |
$0.00 |
| Z6204 |
|
2,151 |
1,927 |
$0.00 |
| Z1034 |
|
8,025 |
6,612 |
$0.00 |
| Z6410 |
|
1,571 |
1,216 |
$0.00 |
| Z6402 |
|
47 |
47 |
$0.00 |
| Z6406 |
|
541 |
536 |
$0.00 |
| G0008 |
Admin influenza virus vac |
159 |
159 |
$0.00 |
| Z1032 |
|
24 |
24 |
$0.00 |
| Z1038 |
|
15 |
15 |
$0.00 |