| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J7304 |
Contraceptive supply, hormone containing patch, each |
30 |
30 |
$37K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
377 |
373 |
$27K |
| J7307 |
Etonogestrel (contraceptive) implant system, including implant and supplies |
15 |
15 |
$15K |
| S4993 |
Contraceptive pills for birth control |
45 |
45 |
$8K |
| J3490 |
Unclassified drugs |
253 |
251 |
$7K |
| S0199 |
Medically induced abortion by oral ingestion of medication including all associated services and supplies (e.g., patient counseling, office visits, confirmation of pregnancy by hcg, ultrasound to confirm duration of pregnancy, ultrasound to confirm completion of abortion) except drugs |
12 |
12 |
$7K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
116 |
113 |
$4K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
80 |
80 |
$3K |
| 87806 |
|
98 |
98 |
$3K |
| A4267 |
Contraceptive supply, condom, male, each |
239 |
237 |
$2K |
| 81025 |
|
653 |
644 |
$2K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
19 |
18 |
$2K |
| S0190 |
Mifepristone, oral, 200 mg |
12 |
12 |
$714.84 |
| Q0111 |
Wet mounts, including preparations of vaginal, cervical or skin specimens |
168 |
166 |
$645.54 |
| 83986 |
|
153 |
151 |
$496.68 |
| 99000 |
|
105 |
105 |
$381.15 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
40 |
40 |
$227.42 |
| S5000 |
Prescription drug, generic |
26 |
26 |
$139.26 |
| 81002 |
|
36 |
36 |
$68.76 |
| S0191 |
Misoprostol, oral, 200 mcg |
12 |
12 |
$35.04 |