| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J7307 |
Etonogestrel (contraceptive) implant system, including implant and supplies |
1,520 |
1,487 |
$1.24M |
| S4993 |
Contraceptive pills for birth control |
3,812 |
3,761 |
$648K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
10,368 |
10,252 |
$402K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
10,361 |
10,247 |
$394K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
5,002 |
4,476 |
$316K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
5,979 |
4,952 |
$243K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
3,257 |
3,119 |
$221K |
| 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 |
356 |
349 |
$210K |
| J7304 |
Contraceptive supply, hormone containing patch, each |
197 |
193 |
$165K |
| J3490 |
Unclassified drugs |
6,416 |
6,178 |
$156K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
1,963 |
1,644 |
$139K |
| A4267 |
Contraceptive supply, condom, male, each |
8,783 |
8,545 |
$101K |
| J7298 |
Levonorgestrel-releasing intrauterine contraceptive system (mirena), 52 mg |
103 |
102 |
$94K |
| 87806 |
|
3,394 |
3,351 |
$86K |
| 58300 |
|
906 |
437 |
$82K |
| 11981 |
|
466 |
442 |
$82K |
| 90651 |
|
298 |
294 |
$64K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
2,143 |
1,904 |
$63K |
| Q0144 |
Azithromycin dihydrate, oral, capsules/powder, 1 gram |
2,165 |
2,117 |
$48K |
| 81025 |
|
13,804 |
13,091 |
$43K |
| 11976 |
|
726 |
355 |
$41K |
| 59840 |
|
150 |
80 |
$37K |
| 57454 |
|
512 |
255 |
$34K |
| S0190 |
Mifepristone, oral, 200 mg |
468 |
444 |
$30K |
| J7300 |
Intrauterine copper contraceptive (paragard) |
41 |
41 |
$28K |
| 99243 |
|
289 |
280 |
$19K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
238 |
147 |
$15K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
143 |
141 |
$15K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
311 |
242 |
$14K |
| 90674 |
|
423 |
421 |
$14K |
| J7303 |
Contraceptive supply, hormone containing vaginal ring, each |
76 |
76 |
$13K |
| Q0111 |
Wet mounts, including preparations of vaginal, cervical or skin specimens |
2,920 |
2,853 |
$12K |
| 83986 |
|
2,922 |
2,853 |
$10K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
474 |
452 |
$9K |
| 99000 |
|
3,378 |
3,108 |
$9K |
| 58301 |
|
297 |
142 |
$9K |
| Q3014 |
Telehealth originating site facility fee |
214 |
211 |
$5K |
| 81002 |
|
1,123 |
1,094 |
$3K |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
381 |
374 |
$2K |
| S0191 |
Misoprostol, oral, 200 mcg |
527 |
503 |
$2K |
| 85018 |
|
514 |
497 |
$1K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
448 |
443 |
$799.46 |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
140 |
140 |
$743.99 |
| S0197 |
Prenatal vitamins, 30-day supply |
205 |
195 |
$229.83 |
| 86901 |
|
93 |
93 |
$209.75 |
| S5000 |
Prescription drug, generic |
2,427 |
1,998 |
$8.00 |
| S5001 |
Prescription drug, brand name |
509 |
502 |
$2.00 |