| Code | Description | Claims | Beneficiaries | Total Paid |
| S9430 |
Pharmacy compounding and dispensing services |
12,756 |
12,284 |
$1.22M |
| S4993 |
Contraceptive pills for birth control |
13,584 |
9,460 |
$309K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
5,094 |
4,988 |
$228K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
1,723 |
1,708 |
$142K |
| J3490 |
Unclassified drugs |
4,109 |
2,891 |
$51K |
| J7307 |
Etonogestrel (contraceptive) implant system, including implant and supplies |
121 |
120 |
$47K |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
1,692 |
1,687 |
$41K |
| 99385 |
|
420 |
418 |
$39K |
| 11981 |
|
95 |
94 |
$38K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
546 |
531 |
$36K |
| 81025 |
|
5,176 |
5,074 |
$34K |
| 58300 |
|
96 |
92 |
$31K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
555 |
550 |
$25K |
| J7304 |
Contraceptive supply, hormone containing patch, each |
31 |
31 |
$23K |
| A4267 |
Contraceptive supply, condom, male, each |
1,761 |
1,688 |
$9K |
| 86780 |
|
648 |
646 |
$8K |
| 86703 |
|
515 |
512 |
$7K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
504 |
503 |
$5K |
| 87210 |
|
982 |
967 |
$5K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
52 |
52 |
$3K |
| 83986 |
|
920 |
906 |
$3K |
| 99384 |
|
30 |
29 |
$3K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
1,017 |
971 |
$3K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
77 |
77 |
$2K |
| 11982 |
|
15 |
15 |
$1K |
| 58301 |
|
25 |
25 |
$1K |
| Q3014 |
Telehealth originating site facility fee |
484 |
482 |
$987.96 |
| 81002 |
|
90 |
90 |
$289.42 |
| 87808 |
|
14 |
14 |
$189.42 |
| A4269 |
Contraceptive supply, spermicide (e.g., foam, gel), each |
21 |
14 |
$149.85 |