| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
1,795 |
1,703 |
$222K |
| T1017 |
Targeted case management, each 15 minutes |
373 |
263 |
$128K |
| 90686 |
|
146 |
142 |
$3K |
| S4993 |
Contraceptive pills for birth control |
152 |
119 |
$1K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
27 |
26 |
$1K |
| 99404 |
|
15 |
12 |
$906.62 |
| 0002A |
|
24 |
24 |
$480.00 |
| 90688 |
|
30 |
28 |
$448.27 |
| 0012A |
|
13 |
13 |
$440.00 |
| 90715 |
|
14 |
14 |
$307.44 |
| S4930 |
|
27 |
26 |
$270.00 |
| 90710 |
|
12 |
12 |
$263.52 |
| 0001A |
|
13 |
13 |
$120.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
12 |
12 |
$108.68 |