| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic service |
75,769 |
63,147 |
$19.54M |
| 99213 |
|
26,085 |
23,627 |
$177K |
| 99212 |
|
11,529 |
10,816 |
$52K |
| 90834 |
|
2,669 |
2,217 |
$30K |
| J3490 |
Drugs unclassified injection |
600 |
446 |
$28K |
| J7307 |
Etonogestrel implant system |
24 |
24 |
$20K |
| 87491 |
|
1,479 |
1,475 |
$13K |
| 87591 |
|
1,468 |
1,464 |
$12K |
| 99202 |
|
472 |
472 |
$10K |
| 99401 |
|
506 |
493 |
$9K |
| 99402 |
|
161 |
160 |
$5K |
| 99203 |
|
720 |
720 |
$4K |
| 81025 |
|
2,089 |
2,060 |
$4K |
| 99214 |
|
10,512 |
9,843 |
$3K |
| 90791 |
|
739 |
735 |
$3K |
| A4267 |
Male condom |
828 |
803 |
$3K |
| 87389 |
|
1,920 |
1,918 |
$2K |
| S5199 |
Personal care item nos each |
733 |
712 |
$2K |
| S4993 |
Contraceptive pills for bc |
140 |
139 |
$1K |
| 90832 |
|
130 |
118 |
$1K |
| 11721 |
|
138 |
138 |
$884.66 |
| 86592 |
|
1,371 |
1,367 |
$676.79 |
| 98960 |
|
76 |
62 |
$624.00 |
| G0467 |
Fqhc visit, estab pt |
76 |
61 |
$474.33 |
| 92507 |
|
12 |
12 |
$390.48 |
| 87210 |
|
152 |
151 |
$209.34 |
| 84443 |
|
893 |
890 |
$189.93 |
| Q0144 |
Azithromycin dihydrate, oral |
19 |
12 |
$168.72 |
| 99406 |
|
219 |
211 |
$140.00 |
| 80053 |
|
1,378 |
1,373 |
$137.85 |
| G2025 |
Dis site tele svcs rhc/fqhc |
33 |
32 |
$119.65 |
| 81001 |
|
89 |
87 |
$110.84 |
| 85025 |
|
1,994 |
1,985 |
$93.52 |
| 90480 |
|
28 |
28 |
$40.00 |
| 97803 |
|
712 |
708 |
$26.11 |
| 87798 |
|
281 |
280 |
$0.00 |
| 80061 |
|
1,512 |
1,506 |
$0.00 |
| 99396 |
|
374 |
360 |
$0.00 |
| 99395 |
|
1,023 |
1,006 |
$0.00 |
| 90460 |
|
311 |
299 |
$0.00 |
| 99392 |
|
185 |
184 |
$0.00 |
| 90715 |
|
468 |
468 |
$0.00 |
| 90633 |
|
343 |
342 |
$0.00 |
| 99404 |
|
311 |
311 |
$0.00 |
| 86708 |
|
403 |
403 |
$0.00 |
| 96160 |
|
501 |
500 |
$0.00 |
| 99394 |
|
185 |
185 |
$0.00 |
| T1013 |
Sign lang/oral interpreter |
1,732 |
1,590 |
$0.00 |
| 86480 |
|
1,342 |
1,340 |
$0.00 |
| 2028F |
|
394 |
391 |
$0.00 |
| 90472 |
|
1,011 |
1,008 |
$0.00 |
| 99204 |
|
245 |
245 |
$0.00 |
| 92134 |
|
18 |
18 |
$0.00 |
| 99173 |
|
2,425 |
2,420 |
$0.00 |
| 90713 |
|
453 |
453 |
$0.00 |
| 86682 |
|
49 |
46 |
$0.00 |
| 90714 |
|
15 |
15 |
$0.00 |
| 83540 |
|
27 |
27 |
$0.00 |
| 90756 |
|
226 |
226 |
$0.00 |
| 99393 |
|
255 |
254 |
$0.00 |
| 90707 |
|
33 |
33 |
$0.00 |
| 82947 |
|
543 |
542 |
$0.00 |
| 82465 |
|
89 |
89 |
$0.00 |
| 81003 |
|
232 |
228 |
$0.00 |
| 90700 |
|
47 |
47 |
$0.00 |
| 99201 |
|
72 |
72 |
$0.00 |
| 99382 |
|
112 |
112 |
$0.00 |
| 92015 |
|
106 |
106 |
$0.00 |
| 69209 |
|
12 |
12 |
$0.00 |
| 90710 |
|
33 |
33 |
$0.00 |
| H1003 |
Prenatal at risk education |
49 |
45 |
$0.00 |
| 90670 |
|
70 |
70 |
$0.00 |
| 83721 |
|
58 |
58 |
$0.00 |
| 90734 |
|
55 |
55 |
$0.00 |
| 90750 |
|
44 |
44 |
$0.00 |
| 90461 |
|
213 |
210 |
$0.00 |
| 81002 |
|
15 |
13 |
$0.00 |
| 59425 |
|
17 |
15 |
$0.00 |
| 90746 |
|
26 |
26 |
$0.00 |
| 90661 |
|
146 |
146 |
$0.00 |
| 80076 |
|
40 |
40 |
$0.00 |
| 87804 |
|
12 |
12 |
$0.00 |
| 91321 |
|
12 |
12 |
$0.00 |
| 87880 |
|
14 |
14 |
$0.00 |
| 99385 |
|
530 |
530 |
$0.00 |
| 36415 |
|
2,204 |
2,158 |
$0.00 |
| 86803 |
|
1,519 |
1,519 |
$0.00 |
| 90651 |
|
445 |
445 |
$0.00 |
| 81015 |
|
72 |
71 |
$0.00 |
| 90632 |
|
40 |
40 |
$0.00 |
| 90732 |
|
12 |
12 |
$0.00 |
| 90471 |
|
3,027 |
2,994 |
$0.00 |
| 96127 |
|
1,416 |
1,275 |
$0.00 |
| 92004 |
|
90 |
90 |
$0.00 |
| S9445 |
Pt education noc individ |
16 |
14 |
$0.00 |
| 86704 |
|
1,379 |
1,379 |
$0.00 |
| 92551 |
|
1,544 |
1,542 |
$0.00 |
| 90686 |
|
500 |
500 |
$0.00 |
| 97802 |
|
429 |
429 |
$0.00 |
| 85018 |
|
204 |
204 |
$0.00 |
| 99000 |
|
2,243 |
2,195 |
$0.00 |
| 83550 |
|
26 |
26 |
$0.00 |
| 90716 |
|
262 |
262 |
$0.00 |
| 99383 |
|
378 |
378 |
$0.00 |
| 86706 |
|
1,476 |
1,476 |
$0.00 |
| 99384 |
|
144 |
144 |
$0.00 |
| 87086 |
|
54 |
53 |
$0.00 |
| 87340 |
|
1,294 |
1,294 |
$0.00 |
| 83036 |
|
768 |
765 |
$0.00 |
| 93000 |
|
60 |
60 |
$0.00 |
| 90744 |
|
167 |
167 |
$0.00 |
| 90636 |
|
57 |
57 |
$0.00 |
| 90698 |
|
12 |
12 |
$0.00 |
| 90674 |
|
110 |
110 |
$0.00 |
| 90792 |
|
80 |
80 |
$0.00 |
| G8510 |
Scr dep neg, no plan reqd |
502 |
501 |
$0.00 |
| 87428 |
|
12 |
12 |
$0.00 |
| 99459 |
|
95 |
95 |
$0.00 |
| 90656 |
|
38 |
38 |
$0.00 |
| 92250 |
|
28 |
28 |
$0.00 |
| 94760 |
|
106 |
98 |
$0.00 |
| 90677 |
|
82 |
81 |
$0.00 |
| 80050 |
|
28 |
28 |
$0.00 |
| 90619 |
|
103 |
103 |
$0.00 |
| 90688 |
|
24 |
24 |
$0.00 |
| 82728 |
|
14 |
14 |
$0.00 |
| 90739 |
|
166 |
166 |
$0.00 |
| 90696 |
|
36 |
36 |
$0.00 |
| 90697 |
|
12 |
12 |
$0.00 |
| 99386 |
|
12 |
12 |
$0.00 |
| 96372 |
|
13 |
12 |
$0.00 |
| 86580 |
|
27 |
26 |
$0.00 |