| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99401 |
|
2,711 |
2,013 |
$72K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
1,483 |
1,017 |
$61K |
| 87806 |
|
2,455 |
2,058 |
$46K |
| J7307 |
Etonogestrel (contraceptive) implant system, including implant and supplies |
101 |
88 |
$43K |
| S4993 |
Contraceptive pills for birth control |
968 |
820 |
$41K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
744 |
608 |
$33K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
702 |
569 |
$32K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
582 |
452 |
$26K |
| 58300 |
|
297 |
241 |
$26K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
1,444 |
955 |
$13K |
| J7297 |
Levonorgestrel-releasing intrauterine contraceptive system (liletta), 52 mg |
78 |
63 |
$12K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
378 |
294 |
$12K |
| J7300 |
Intrauterine copper contraceptive (paragard) |
43 |
32 |
$12K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
194 |
170 |
$9K |
| 11981 |
|
98 |
85 |
$8K |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
102 |
82 |
$7K |
| 81025 |
|
1,656 |
1,296 |
$6K |
| J8499 |
Prescription drug, oral, non chemotherapeutic, nos |
286 |
215 |
$3K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
34 |
31 |
$3K |
| 87801 |
Infectious agent detection by nucleic acid; amplified probe, multiple organisms |
126 |
124 |
$3K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
122 |
83 |
$3K |
| 87210 |
|
453 |
346 |
$2K |
| 83986 |
|
421 |
286 |
$1K |
| 11982 |
|
15 |
12 |
$1K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
16 |
16 |
$1K |
| 58301 |
|
16 |
13 |
$579.70 |
| 86901 |
|
122 |
102 |
$559.30 |
| 85018 |
|
179 |
155 |
$396.72 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
18 |
12 |
$391.95 |
| 76830 |
Ultrasound, transvaginal |
47 |
45 |
$358.18 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
15 |
15 |
$192.73 |
| 81002 |
|
67 |
48 |
$171.60 |
| S0191 |
Misoprostol, oral, 200 mcg |
88 |
67 |
$0.00 |