| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic service |
393,410 |
343,252 |
$57.06M |
| G0470 |
Fqhc visit, mh estab pt |
39,791 |
37,028 |
$6.48M |
| T1040 |
Comm bh clinic svc per diem |
22,688 |
15,018 |
$3.03M |
| 90834 |
|
24,067 |
17,548 |
$1.83M |
| 99050 |
|
37,998 |
36,262 |
$1.76M |
| 99392 |
|
12,093 |
11,715 |
$1.68M |
| G0467 |
Fqhc visit, estab pt |
35,970 |
29,733 |
$1.54M |
| 99391 |
|
9,613 |
9,208 |
$1.38M |
| 90460 |
|
33,930 |
33,538 |
$1.27M |
| 99393 |
|
7,001 |
6,865 |
$954K |
| 92014 |
|
10,188 |
9,944 |
$826K |
| 90832 |
|
19,091 |
14,806 |
$754K |
| 99394 |
|
4,356 |
4,330 |
$647K |
| 99213 |
|
73,937 |
68,086 |
$610K |
| 87635 |
|
9,686 |
9,554 |
$475K |
| 96110 |
|
45,260 |
43,276 |
$462K |
| 92340 |
|
16,123 |
14,400 |
$449K |
| 99395 |
|
2,503 |
2,489 |
$418K |
| 90461 |
|
11,996 |
11,798 |
$355K |
| 99381 |
|
1,646 |
1,637 |
$338K |
| 90471 |
|
25,437 |
25,162 |
$328K |
| S0302 |
Completed epsdt |
38,852 |
37,292 |
$309K |
| 99214 |
|
29,795 |
27,863 |
$267K |
| 99173 |
|
9,152 |
9,118 |
$184K |
| 87502 |
|
2,277 |
2,257 |
$172K |
| 90686 |
|
25,749 |
25,642 |
$153K |
| 92015 |
|
12,673 |
12,410 |
$151K |
| 97802 |
|
2,952 |
2,942 |
$148K |
| 97803 |
|
4,091 |
3,823 |
$145K |
| 92551 |
|
14,676 |
14,639 |
$140K |
| 99188 |
|
5,402 |
5,385 |
$138K |
| 87880 |
|
10,611 |
10,426 |
$130K |
| H2016 |
Comp comm supp svc, per diem |
2,341 |
1,031 |
$127K |
| 90677 |
|
1,436 |
1,427 |
$120K |
| 99607 |
|
2,643 |
2,092 |
$106K |
| 92341 |
|
3,150 |
3,122 |
$105K |
| 90746 |
|
1,590 |
1,588 |
$102K |
| 90791 |
|
857 |
822 |
$98K |
| 90715 |
|
3,325 |
3,317 |
$87K |
| 99606 |
|
2,095 |
1,948 |
$86K |
| G2025 |
Dis site tele svcs rhc/fqhc |
4,996 |
4,212 |
$85K |
| G2023 |
Specimen collect covid-19 |
2,812 |
2,748 |
$79K |
| 0012A |
|
1,755 |
1,754 |
$78K |
| 90651 |
|
2,080 |
2,075 |
$69K |
| 81025 |
|
10,298 |
9,715 |
$68K |
| 90792 |
|
719 |
715 |
$64K |
| 59400 |
|
28 |
28 |
$55K |
| 90837 |
|
554 |
403 |
$53K |
| 0011A |
|
1,186 |
1,186 |
$50K |
| 99211 |
|
3,191 |
2,460 |
$44K |
| 96127 |
|
4,004 |
3,959 |
$39K |
| 99212 |
|
2,252 |
2,171 |
$37K |
| 90662 |
|
2,300 |
2,282 |
$36K |
| T1502 |
Medication admin visit |
613 |
187 |
$36K |
| 0001A |
|
729 |
729 |
$33K |
| 59025 |
|
1,276 |
540 |
$33K |
| J1050 |
Medroxyprogesterone acetate |
1,187 |
1,182 |
$32K |
| G0108 |
Diab manage trn per indiv |
750 |
728 |
$30K |
| 96372 |
|
2,384 |
2,338 |
$28K |
| 90472 |
|
2,962 |
2,940 |
$27K |
| 87804 |
|
2,095 |
1,202 |
$27K |
| 87651 |
|
822 |
808 |
$25K |
| 0002A |
|
524 |
523 |
$24K |
| 90688 |
|
4,860 |
4,850 |
$22K |
| 99396 |
|
519 |
518 |
$22K |
| 90670 |
|
5,540 |
5,369 |
$19K |
| 99402 |
|
455 |
420 |
$19K |
| 90853 |
|
639 |
361 |
$18K |
| 90480 |
|
426 |
426 |
$15K |
| 83036 |
|
2,802 |
2,790 |
$13K |
| 90713 |
|
621 |
616 |
$13K |
| J7307 |
Etonogestrel implant system |
26 |
26 |
$10K |
| 93000 |
|
680 |
670 |
$10K |
| G0469 |
Fqhc visit, mh new pt |
36 |
36 |
$9K |
| 92012 |
|
138 |
133 |
$8K |
| 90707 |
|
448 |
443 |
$7K |
| 91322 |
|
145 |
145 |
$7K |
| 90785 |
|
1,465 |
1,117 |
$7K |
| 99383 |
|
42 |
42 |
$7K |
| 99397 |
|
293 |
282 |
$6K |
| 36415 |
|
5,222 |
5,116 |
$6K |
| G0466 |
Fqhc visit new patient |
136 |
134 |
$6K |
| 99384 |
|
39 |
39 |
$6K |
| 82947 |
|
2,013 |
1,833 |
$5K |
| 90714 |
|
240 |
239 |
$5K |
| 99385 |
|
26 |
26 |
$5K |
| 99051 |
|
5,110 |
4,705 |
$5K |
| 90732 |
|
76 |
76 |
$5K |
| 90716 |
|
303 |
299 |
$5K |
| 81002 |
|
1,794 |
1,757 |
$5K |
| 92134 |
|
187 |
113 |
$4K |
| 81000 |
|
1,293 |
1,258 |
$4K |
| 80305 |
|
481 |
452 |
$4K |
| G0299 |
Hhs/hospice of rn ea 15 min |
52 |
50 |
$4K |
| 90882 |
|
109 |
103 |
$4K |
| 97810 |
|
139 |
79 |
$4K |
| 0031A |
|
79 |
79 |
$4K |
| 99215 |
Prolong outpt/office vis |
1,028 |
956 |
$4K |
| 99605 |
|
58 |
58 |
$3K |
| Q0091 |
Obtaining screen pap smear |
227 |
227 |
$3K |
| 91320 |
|
29 |
29 |
$3K |
| 97811 |
|
139 |
79 |
$3K |
| H0046 |
Mental health service, nos |
82 |
69 |
$3K |
| S3005 |
Eval self-assess depression |
254 |
252 |
$3K |
| 87634 |
|
34 |
34 |
$2K |
| 93005 |
|
283 |
282 |
$2K |
| 99024 |
|
10,076 |
8,792 |
$2K |
| 11976 |
|
13 |
13 |
$1K |
| 90847 |
|
12 |
12 |
$1K |
| 92133 |
|
69 |
38 |
$1K |
| 90674 |
|
285 |
284 |
$1K |
| 58300 |
|
12 |
12 |
$810.30 |
| 87808 |
|
67 |
67 |
$779.46 |
| 99000 |
|
38,489 |
36,638 |
$740.65 |
| 90621 |
|
198 |
197 |
$657.64 |
| G0008 |
Admin influenza virus vac |
2,535 |
2,521 |
$649.00 |
| 0054A |
|
14 |
14 |
$640.69 |
| 92250 |
|
16 |
12 |
$502.51 |
| 99203 |
|
159 |
157 |
$498.25 |
| D0140 |
|
3,367 |
3,105 |
$432.00 |
| 99401 |
|
14 |
13 |
$420.01 |
| 86580 |
|
55 |
51 |
$332.88 |
| 90734 |
|
910 |
909 |
$320.45 |
| 87905 |
|
38 |
38 |
$315.00 |
| 99406 |
|
924 |
852 |
$310.24 |
| 90656 |
|
1,394 |
1,362 |
$285.33 |
| 92370 |
|
25 |
25 |
$279.75 |
| 99442 |
|
12 |
12 |
$249.72 |
| J2315 |
Naltrexone, depot form |
247 |
244 |
$248.74 |
| 88142 |
|
12 |
12 |
$214.44 |
| D9110 |
|
2,757 |
2,450 |
$204.00 |
| 99204 |
|
14 |
14 |
$181.18 |
| D1110 |
|
786 |
675 |
$151.00 |
| D0220 |
|
4,499 |
4,123 |
$142.00 |
| 82951 |
|
12 |
12 |
$136.20 |
| 91321 |
|
70 |
66 |
$111.84 |
| D2392 |
|
45 |
36 |
$70.00 |
| D2391 |
|
122 |
82 |
$55.00 |
| 90633 |
|
2,227 |
2,209 |
$49.88 |
| D0120 |
|
232 |
177 |
$46.00 |
| D0150 |
|
582 |
533 |
$37.00 |
| 90474 |
|
25 |
25 |
$19.68 |
| 90691 |
|
19 |
19 |
$18.00 |
| D0230 |
|
755 |
364 |
$12.00 |
| 36416 |
|
3,183 |
3,103 |
$4.40 |
| 94640 |
|
61 |
58 |
$4.33 |
| 90648 |
|
4,661 |
4,504 |
$2.00 |
| 90697 |
|
840 |
834 |
$1.30 |
| 90723 |
|
2,505 |
2,396 |
$1.00 |
| 90750 |
|
38 |
38 |
$0.65 |
| 90685 |
|
922 |
920 |
$0.30 |
| 91301 |
|
5,366 |
5,323 |
$0.01 |
| D9450 |
|
7,420 |
6,006 |
$0.00 |
| D1330 |
|
3,486 |
3,160 |
$0.00 |
| D0603 |
|
851 |
797 |
$0.00 |
| D1310 |
|
1,650 |
1,509 |
$0.00 |
| 90680 |
|
662 |
661 |
$0.00 |
| 91303 |
|
203 |
203 |
$0.00 |
| 90619 |
|
237 |
231 |
$0.00 |
| G0009 |
Admin pneumococcal vaccine |
381 |
377 |
$0.00 |
| 91305 |
|
771 |
766 |
$0.00 |
| D9995 |
|
605 |
549 |
$0.00 |
| J1885 |
Ketorolac tromethamine inj |
38 |
37 |
$0.00 |
| A9150 |
Misc/exper non-prescript dru |
244 |
223 |
$0.00 |
| D0210 |
|
411 |
374 |
$0.00 |
| 91307 |
|
323 |
315 |
$0.00 |
| 90696 |
|
73 |
73 |
$0.00 |
| D7140 |
|
152 |
90 |
$0.00 |
| D0602 |
|
47 |
45 |
$0.00 |
| J7611 |
Albuterol non-comp con |
48 |
46 |
$0.00 |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
24 |
13 |
$0.00 |
| D1206 |
|
16 |
14 |
$0.00 |
| 90744 |
|
12 |
12 |
$0.00 |
| 90869 |
|
50 |
50 |
$0.00 |
| 90718 |
|
12 |
12 |
$0.00 |
| D2393 |
|
12 |
12 |
$0.00 |
| 91300 |
|
2,385 |
2,168 |
$0.00 |
| V2020 |
Vision svcs frames purchases |
45 |
45 |
$0.00 |
| D0270 |
|
57 |
56 |
$0.00 |
| 90700 |
|
117 |
113 |
$0.00 |
| 90681 |
|
696 |
649 |
$0.00 |
| 90710 |
|
81 |
81 |
$0.00 |
| D0330 |
|
41 |
39 |
$0.00 |
| D0274 |
|
53 |
46 |
$0.00 |
| 0004A |
|
17 |
17 |
$0.00 |
| 91312 |
|
175 |
165 |
$0.00 |
| D0191 |
|
18 |
15 |
$0.00 |
| 90687 |
|
28 |
28 |
$0.00 |
| V2760 |
Scratch resistant coating |
90 |
45 |
$0.00 |
| G0468 |
Fqhc visit, ippe or awv |
22 |
22 |
$0.00 |