| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic service |
71,516 |
60,986 |
$10.14M |
| T1040 |
Comm bh clinic svc per diem |
3,213 |
1,858 |
$435K |
| G0467 |
Fqhc visit, estab pt |
9,762 |
7,853 |
$369K |
| 99050 |
|
7,283 |
6,714 |
$342K |
| 99393 |
|
1,847 |
1,845 |
$272K |
| 99392 |
|
1,661 |
1,651 |
$270K |
| 99394 |
|
1,476 |
1,474 |
$221K |
| 99213 |
|
33,689 |
30,070 |
$216K |
| G0470 |
Fqhc visit, mh estab pt |
831 |
762 |
$181K |
| 99395 |
|
897 |
890 |
$155K |
| 99391 |
|
836 |
824 |
$147K |
| 99214 |
|
9,465 |
8,872 |
$101K |
| 90471 |
|
8,029 |
7,844 |
$82K |
| 96110 |
|
7,350 |
6,968 |
$73K |
| 90832 |
|
1,273 |
905 |
$72K |
| 99396 |
|
800 |
795 |
$67K |
| 99173 |
|
2,961 |
2,955 |
$66K |
| G2025 |
Dis site tele svcs rhc/fqhc |
2,993 |
2,542 |
$54K |
| 90834 |
|
575 |
371 |
$49K |
| 90460 |
|
4,286 |
3,442 |
$48K |
| 97802 |
|
577 |
575 |
$40K |
| 99204 |
|
561 |
560 |
$37K |
| 92340 |
|
1,254 |
1,150 |
$36K |
| 92004 |
|
507 |
505 |
$33K |
| 92015 |
|
2,452 |
2,436 |
$31K |
| 92014 |
|
598 |
597 |
$29K |
| 99051 |
|
1,530 |
1,480 |
$23K |
| 90472 |
|
2,843 |
2,026 |
$21K |
| G2023 |
Specimen collect covid-19 |
857 |
811 |
$18K |
| 99212 |
|
1,230 |
1,140 |
$17K |
| 90686 |
|
3,119 |
3,107 |
$13K |
| 90674 |
|
1,169 |
1,156 |
$13K |
| 90651 |
|
644 |
582 |
$13K |
| 90715 |
|
624 |
621 |
$13K |
| 83036 |
|
1,394 |
1,378 |
$12K |
| D1120 |
|
196 |
194 |
$10K |
| 97803 |
|
278 |
272 |
$10K |
| 87880 |
|
785 |
760 |
$9K |
| D9450 |
|
695 |
430 |
$8K |
| D1206 |
|
234 |
232 |
$6K |
| 81002 |
|
2,021 |
1,417 |
$5K |
| 90734 |
|
516 |
455 |
$5K |
| 87502 |
|
70 |
67 |
$5K |
| 90670 |
|
623 |
616 |
$5K |
| 81025 |
|
745 |
712 |
$5K |
| 87635 |
|
86 |
85 |
$4K |
| 99381 |
|
24 |
24 |
$4K |
| 0001A |
|
98 |
98 |
$4K |
| 0002A |
|
88 |
88 |
$4K |
| D1110 |
|
162 |
90 |
$4K |
| 87804 |
|
391 |
176 |
$4K |
| S4989 |
Contracept iud |
15 |
12 |
$3K |
| 90661 |
|
103 |
103 |
$3K |
| 99211 |
|
2,158 |
1,836 |
$2K |
| J1050 |
Medroxyprogesterone acetate |
72 |
71 |
$2K |
| 90716 |
|
332 |
319 |
$2K |
| D2392 |
|
63 |
28 |
$2K |
| U0002 |
Covid-19 lab test non-cdc |
33 |
19 |
$2K |
| 90694 |
|
200 |
161 |
$2K |
| D0210 |
|
52 |
28 |
$2K |
| D0140 |
|
83 |
41 |
$2K |
| D0150 |
|
49 |
37 |
$1K |
| 81000 |
|
461 |
334 |
$1K |
| 90707 |
|
338 |
336 |
$1K |
| S0302 |
Completed epsdt |
1,733 |
1,725 |
$1K |
| 93000 |
|
81 |
80 |
$1K |
| 90750 |
|
35 |
13 |
$996.67 |
| D0120 |
|
76 |
48 |
$957.00 |
| 81003 |
|
432 |
401 |
$925.32 |
| 90746 |
|
12 |
12 |
$804.72 |
| 90461 |
|
284 |
284 |
$797.04 |
| D0274 |
|
46 |
28 |
$766.00 |
| D0220 |
|
72 |
35 |
$542.00 |
| 90474 |
|
68 |
68 |
$485.65 |
| D0180 |
|
22 |
12 |
$428.00 |
| 87651 |
|
12 |
12 |
$371.40 |
| 99188 |
|
14 |
14 |
$364.00 |
| 86580 |
|
56 |
54 |
$326.91 |
| 0012A |
|
15 |
15 |
$323.91 |
| S3005 |
Eval self-assess depression |
39 |
39 |
$297.83 |
| G0008 |
Admin influenza virus vac |
397 |
383 |
$278.82 |
| 0134A |
|
13 |
13 |
$275.23 |
| 92551 |
|
26 |
26 |
$243.88 |
| 90653 |
|
74 |
60 |
$204.88 |
| 96372 |
|
512 |
456 |
$151.69 |
| 80305 |
|
17 |
12 |
$142.72 |
| 94640 |
|
303 |
288 |
$117.84 |
| 87210 |
|
26 |
26 |
$109.60 |
| 91300 |
|
833 |
767 |
$80.41 |
| 0011A |
|
23 |
16 |
$33.89 |
| J7613 |
Albuterol non-comp unit |
191 |
185 |
$2.51 |
| J7620 |
Albuterol ipratrop non-comp |
13 |
13 |
$0.09 |
| 91301 |
|
217 |
198 |
$0.08 |
| 90723 |
|
384 |
384 |
$0.00 |
| 90680 |
|
362 |
362 |
$0.00 |
| 90656 |
|
316 |
312 |
$0.00 |
| 90696 |
|
13 |
13 |
$0.00 |
| 90619 |
|
12 |
12 |
$0.00 |
| G0101 |
Ca screen;pelvic/breast exam |
582 |
566 |
$0.00 |
| Q0091 |
Obtaining screen pap smear |
381 |
381 |
$0.00 |
| 90648 |
|
594 |
589 |
$0.00 |
| 90633 |
|
516 |
514 |
$0.00 |
| 90691 |
|
176 |
176 |
$0.00 |
| 90700 |
|
71 |
68 |
$0.00 |
| 91313 |
|
13 |
13 |
$0.00 |