| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J7307 |
Etonogestrel (contraceptive) implant system, including implant and supplies |
494 |
491 |
$408K |
| S4993 |
Contraceptive pills for birth control |
1,288 |
1,284 |
$192K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
2,736 |
2,727 |
$103K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,562 |
1,970 |
$103K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
2,735 |
2,726 |
$102K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
950 |
946 |
$66K |
| J3490 |
Unclassified drugs |
1,847 |
1,812 |
$44K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
632 |
520 |
$40K |
| J7304 |
Contraceptive supply, hormone containing patch, each |
26 |
26 |
$26K |
| 57454 |
|
358 |
179 |
$24K |
| A4267 |
Contraceptive supply, condom, male, each |
2,056 |
2,016 |
$24K |
| 87806 |
|
934 |
923 |
$24K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
718 |
569 |
$20K |
| 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 |
32 |
32 |
$19K |
| 90651 |
|
63 |
62 |
$14K |
| Q0144 |
Azithromycin dihydrate, oral, capsules/powder, 1 gram |
666 |
651 |
$13K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
155 |
135 |
$12K |
| 81025 |
|
3,551 |
3,449 |
$11K |
| 11981 |
|
58 |
58 |
$9K |
| 90674 |
|
163 |
161 |
$5K |
| 11976 |
|
78 |
39 |
$5K |
| S0190 |
Mifepristone, oral, 200 mg |
39 |
39 |
$3K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
41 |
32 |
$3K |
| Q0111 |
Wet mounts, including preparations of vaginal, cervical or skin specimens |
620 |
616 |
$3K |
| 83986 |
|
619 |
616 |
$2K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
78 |
78 |
$2K |
| 99000 |
|
598 |
582 |
$1K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
161 |
159 |
$325.58 |
| 81002 |
|
113 |
113 |
$274.89 |
| S0191 |
Misoprostol, oral, 200 mcg |
39 |
39 |
$123.48 |
| 85018 |
|
16 |
15 |
$37.68 |
| S5000 |
Prescription drug, generic |
245 |
235 |
$0.00 |
| S5001 |
Prescription drug, brand name |
14 |
14 |
$0.00 |