| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 81513 |
|
256 |
254 |
$30K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
1,015 |
1,004 |
$28K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
1,015 |
1,004 |
$28K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
222 |
222 |
$16K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
467 |
425 |
$12K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
129 |
129 |
$9K |
| S4993 |
Contraceptive pills for birth control |
104 |
103 |
$8K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
198 |
186 |
$8K |
| 87661 |
Infectious agent detection by nucleic acid; Trichomonas vaginalis, amplified probe |
256 |
254 |
$7K |
| 88142 |
|
454 |
454 |
$7K |
| 84703 |
|
892 |
860 |
$5K |
| 87624 |
Infectious agent detection by nucleic acid; human papillomavirus (HPV), high-risk types |
116 |
116 |
$3K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
241 |
238 |
$3K |
| 99385 |
|
59 |
59 |
$2K |
| 87800 |
|
24 |
24 |
$843.64 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
13 |
13 |
$449.00 |
| A4267 |
Contraceptive supply, condom, male, each |
87 |
84 |
$330.60 |
| 81003 |
|
26 |
26 |
$49.14 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
13 |
13 |
$0.00 |
| 3074F |
|
126 |
123 |
$0.00 |
| 1000F |
|
180 |
174 |
$0.00 |
| 3008F |
|
171 |
165 |
$0.00 |
| 1036F |
|
81 |
80 |
$0.00 |
| 3079F |
|
30 |
29 |
$0.00 |
| 1160F |
|
157 |
152 |
$0.00 |
| 87481 |
|
161 |
160 |
$0.00 |
| 3078F |
|
106 |
103 |
$0.00 |