| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S4993 |
Contraceptive pills for birth control |
2,308 |
2,118 |
$303K |
| A4267 |
Contraceptive supply, condom, male, each |
11,248 |
9,419 |
$149K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
5,345 |
4,615 |
$126K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
1,958 |
1,802 |
$83K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,340 |
2,181 |
$74K |
| J7307 |
Etonogestrel (contraceptive) implant system, including implant and supplies |
151 |
137 |
$74K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
1,584 |
1,456 |
$70K |
| 81025 |
|
5,525 |
4,979 |
$26K |
| A9150 |
Non-prescription drugs |
609 |
581 |
$12K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
1,173 |
1,135 |
$11K |
| 81002 |
|
3,980 |
3,677 |
$7K |
| 11982 |
|
86 |
79 |
$7K |
| 11981 |
|
92 |
80 |
$5K |
| 99000 |
|
362 |
300 |
$3K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
91 |
90 |
$3K |
| 87624 |
Infectious agent detection by nucleic acid; human papillomavirus (HPV), high-risk types |
1,267 |
1,200 |
$2K |
| 85018 |
|
3,810 |
3,478 |
$2K |
| 87210 |
|
1,324 |
1,217 |
$1K |
| 58301 |
|
13 |
13 |
$946.96 |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
337 |
296 |
$662.79 |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
337 |
296 |
$662.79 |
| 80061 |
Lipid panel |
30 |
30 |
$114.90 |
| 86701 |
|
185 |
170 |
$57.54 |
| 86592 |
|
88 |
83 |
$3.59 |
| Q0144 |
Azithromycin dihydrate, oral, capsules/powder, 1 gram |
27 |
25 |
$0.00 |
| A4550 |
Surgical trays |
84 |
46 |
$0.00 |
| J3490 |
Unclassified drugs |
2,213 |
1,242 |
$0.00 |
| 88142 |
|
228 |
221 |
$0.00 |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
65 |
63 |
$0.00 |