| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J7307 |
Etonogestrel (contraceptive) implant system, including implant and supplies |
286 |
281 |
$233K |
| S4993 |
Contraceptive pills for birth control |
1,039 |
1,034 |
$205K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
2,451 |
2,440 |
$106K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
2,451 |
2,440 |
$105K |
| J7304 |
Contraceptive supply, hormone containing patch, each |
84 |
83 |
$96K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,222 |
2,086 |
$81K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
918 |
880 |
$63K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
734 |
733 |
$55K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,398 |
1,321 |
$41K |
| 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 |
53 |
53 |
$30K |
| J3490 |
Unclassified drugs |
1,109 |
1,075 |
$26K |
| Q3014 |
Telehealth originating site facility fee |
1,207 |
1,151 |
$24K |
| A4267 |
Contraceptive supply, condom, male, each |
1,674 |
1,625 |
$19K |
| 11981 |
|
104 |
95 |
$19K |
| 87806 |
|
682 |
675 |
$16K |
| 11976 |
|
213 |
103 |
$12K |
| 81025 |
|
2,744 |
2,619 |
$8K |
| 58300 |
|
82 |
40 |
$8K |
| 90674 |
|
203 |
199 |
$6K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
44 |
44 |
$5K |
| J7303 |
Contraceptive supply, hormone containing vaginal ring, each |
33 |
25 |
$5K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
36 |
35 |
$4K |
| 57454 |
|
66 |
31 |
$4K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
43 |
43 |
$4K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
50 |
49 |
$3K |
| Q0144 |
Azithromycin dihydrate, oral, capsules/powder, 1 gram |
464 |
448 |
$2K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
111 |
111 |
$2K |
| 96156 |
|
28 |
28 |
$2K |
| Q0111 |
Wet mounts, including preparations of vaginal, cervical or skin specimens |
344 |
341 |
$1K |
| 99000 |
|
621 |
603 |
$1K |
| 83986 |
|
343 |
340 |
$1K |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
213 |
203 |
$1K |
| 58301 |
|
28 |
13 |
$734.79 |
| 81002 |
|
274 |
268 |
$639.31 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
273 |
267 |
$490.60 |
| S5000 |
Prescription drug, generic |
624 |
495 |
$0.00 |
| S5001 |
Prescription drug, brand name |
40 |
40 |
$0.00 |
| 1159F |
|
14 |
14 |
$0.00 |
| 1160F |
|
14 |
14 |
$0.00 |