| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1017 |
Targeted case management, each 15 minutes |
3,408 |
2,613 |
$1.13M |
| T1015 |
Clinic visit/encounter, all-inclusive |
603 |
576 |
$85K |
| 87801 |
Infectious agent detection by nucleic acid; amplified probe, multiple organisms |
1,188 |
1,142 |
$12K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
866 |
798 |
$6K |
| 99201 |
|
115 |
114 |
$3K |
| S4993 |
Contraceptive pills for birth control |
332 |
267 |
$3K |
| S4930 |
|
65 |
65 |
$650.00 |
| 90715 |
|
113 |
106 |
$634.36 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
381 |
360 |
$431.99 |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
12 |
12 |
$360.00 |
| 81025 |
|
53 |
46 |
$223.12 |
| 86580 |
|
23 |
14 |
$118.66 |
| 99401 |
|
46 |
38 |
$94.12 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
88 |
84 |
$93.30 |
| A4267 |
Contraceptive supply, condom, male, each |
12 |
12 |
$22.08 |
| 90633 |
|
54 |
54 |
$0.00 |
| 90707 |
|
12 |
12 |
$0.00 |
| 99000 |
|
1,470 |
1,383 |
$0.00 |
| Q2036 |
Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (flulaval) |
13 |
13 |
$0.00 |