| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J2315 |
Naltrexone, depot form |
4,223 |
3,591 |
$3.82M |
| 99401 |
|
6,450 |
5,559 |
$142K |
| 99214 |
|
1,814 |
1,565 |
$94K |
| 99213 |
|
2,562 |
2,211 |
$88K |
| J1050 |
Medroxyprogesterone acetate |
1,088 |
957 |
$86K |
| 99211 |
|
4,842 |
4,131 |
$53K |
| 80305 |
|
4,635 |
3,673 |
$32K |
| 96372 |
|
1,175 |
1,010 |
$13K |
| 90632 |
|
192 |
182 |
$9K |
| 90471 |
|
735 |
641 |
$9K |
| 90460 |
|
346 |
336 |
$7K |
| 99204 |
|
98 |
91 |
$7K |
| 81025 |
|
546 |
492 |
$3K |
| 99203 |
|
74 |
66 |
$3K |
| 90686 |
|
252 |
224 |
$2K |
| 80306 |
|
568 |
361 |
$2K |
| 99406 |
|
164 |
144 |
$1K |
| 81002 |
|
952 |
860 |
$1K |
| G0477 |
Drug test presump optical |
254 |
163 |
$893.45 |
| 99202 |
|
12 |
12 |
$449.07 |
| 90734 |
|
246 |
240 |
$270.28 |
| G0397 |
Alcohol/subs interv >30 min |
16 |
13 |
$197.86 |
| G0396 |
Alcohol/subs interv 15-30mn |
56 |
44 |
$179.10 |
| 99408 |
|
82 |
67 |
$150.00 |
| G0442 |
Annual alcohol screen 15 min |
50 |
43 |
$150.00 |
| 90715 |
|
79 |
71 |
$142.94 |
| 90472 |
|
40 |
18 |
$107.86 |
| 36415 |
|
44 |
42 |
$86.77 |
| A4267 |
Male condom |
167 |
148 |
$63.18 |
| H0049 |
Alcohol/drug screening |
49 |
41 |
$50.00 |
| 96160 |
|
29 |
29 |
$24.01 |
| G0008 |
Admin influenza virus vac |
228 |
204 |
$24.00 |
| H0048 |
Spec coll non-blood:a/d test |
40 |
31 |
$8.40 |
| 90633 |
|
17 |
17 |
$0.11 |
| 90649 |
|
59 |
57 |
$0.02 |
| G0445 |
High inten beh couns std 30m |
168 |
151 |
$0.00 |
| G8482 |
Flu immunize order/admin |
241 |
213 |
$0.00 |
| H0050 |
Alcohol/drug service 15 min |
54 |
41 |
$0.00 |
| G0481 |
Drug test def 8-14 classes |
115 |
86 |
$0.00 |