| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
644 |
555 |
$53K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
731 |
595 |
$21K |
| 87806 |
|
801 |
739 |
$16K |
| J8499 |
Prescription drug, oral, non chemotherapeutic, nos |
374 |
342 |
$10K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
130 |
103 |
$6K |
| 81025 |
|
1,177 |
980 |
$6K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
552 |
407 |
$5K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
38 |
38 |
$3K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
13 |
13 |
$1K |
| 87210 |
|
178 |
153 |
$798.19 |
| S4993 |
Contraceptive pills for birth control |
26 |
25 |
$730.15 |
| 99070 |
|
17 |
14 |
$595.00 |
| 99401 |
|
19 |
16 |
$570.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
14 |
13 |
$560.82 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
22 |
22 |
$283.36 |