| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
115 |
115 |
$3K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
115 |
115 |
$3K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
132 |
131 |
$3K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
16 |
16 |
$2K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
28 |
27 |
$2K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
14 |
14 |
$483.51 |
| 81025 |
|
33 |
31 |
$367.52 |
| 87480 |
|
12 |
12 |
$277.04 |
| 87660 |
|
12 |
12 |
$275.07 |
| 86803 |
|
12 |
12 |
$250.80 |
| 86780 |
|
12 |
12 |
$200.40 |
| 87510 |
|
12 |
12 |
$194.04 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
13 |
13 |
$191.06 |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
127 |
127 |
$0.00 |
| S4993 |
Contraceptive pills for birth control |
12 |
12 |
$0.00 |