| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1017 |
Targeted case management, each 15 minutes |
8,526 |
6,053 |
$3.41M |
| H2018 |
Psychosocial rehabilitation services, per diem |
587 |
240 |
$727K |
| T1015 |
Clinic visit/encounter, all-inclusive |
915 |
873 |
$115K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,230 |
923 |
$74K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,545 |
1,412 |
$30K |
| 90686 |
|
857 |
848 |
$18K |
| 90715 |
|
665 |
645 |
$15K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
431 |
328 |
$14K |
| 90707 |
|
466 |
447 |
$14K |
| 90682 |
|
340 |
327 |
$13K |
| 99215 |
Prolong outpt/office vis |
174 |
131 |
$12K |
| 86580 |
|
1,481 |
1,203 |
$11K |
| T1016 |
Case management, each 15 minutes |
136 |
51 |
$11K |
| 90716 |
|
229 |
219 |
$10K |
| 90633 |
|
451 |
439 |
$10K |
| 91322 |
|
104 |
98 |
$8K |
| 90688 |
|
244 |
233 |
$4K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
180 |
179 |
$4K |
| S4993 |
Contraceptive pills for birth control |
339 |
281 |
$4K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
90 |
82 |
$3K |
| 90480 |
|
112 |
104 |
$3K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
127 |
126 |
$3K |
| 90670 |
|
90 |
88 |
$2K |
| 0011A |
|
264 |
211 |
$2K |
| 90839 |
|
35 |
25 |
$2K |
| 90696 |
|
101 |
97 |
$2K |
| 0012A |
|
196 |
150 |
$2K |
| 90656 |
|
88 |
84 |
$2K |
| 90710 |
|
66 |
66 |
$1K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
29 |
26 |
$1K |
| 90651 |
|
28 |
26 |
$1K |
| 90648 |
|
46 |
44 |
$944.28 |
| 81025 |
|
159 |
151 |
$929.66 |
| 90723 |
|
44 |
42 |
$922.32 |
| 90734 |
|
29 |
28 |
$792.46 |
| 90713 |
|
28 |
28 |
$644.56 |
| 90744 |
|
27 |
27 |
$570.96 |
| S4930 |
|
59 |
58 |
$551.22 |
| 90746 |
|
12 |
12 |
$546.59 |
| H2010 |
Comprehensive medication services, per 15 minutes |
14 |
12 |
$467.60 |
| 90632 |
|
13 |
13 |
$324.09 |
| 91321 |
|
13 |
13 |
$285.48 |
| 90700 |
|
12 |
12 |
$263.52 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
19 |
13 |
$235.27 |
| 87210 |
|
30 |
30 |
$113.96 |
| 36415 |
Collection of venous blood by venipuncture |
26 |
26 |
$54.60 |
| A4267 |
Contraceptive supply, condom, male, each |
13 |
13 |
$23.40 |
| 91301 |
|
258 |
248 |
$0.00 |