| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S4993 |
Contraceptive pills for birth control |
2,213 |
2,204 |
$314K |
| J7307 |
Etonogestrel (contraceptive) implant system, including implant and supplies |
208 |
205 |
$170K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
1,646 |
1,645 |
$67K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,627 |
1,344 |
$67K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
1,646 |
1,644 |
$66K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
587 |
586 |
$41K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
978 |
797 |
$30K |
| A4267 |
Contraceptive supply, condom, male, each |
1,646 |
1,625 |
$19K |
| J7298 |
Levonorgestrel-releasing intrauterine contraceptive system (mirena), 52 mg |
25 |
24 |
$17K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
248 |
235 |
$16K |
| J3490 |
Unclassified drugs |
583 |
579 |
$14K |
| 87806 |
|
498 |
498 |
$12K |
| Q0144 |
Azithromycin dihydrate, oral, capsules/powder, 1 gram |
349 |
342 |
$11K |
| 57454 |
|
130 |
65 |
$9K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
86 |
73 |
$7K |
| 58300 |
|
61 |
29 |
$5K |
| 81025 |
|
1,603 |
1,584 |
$5K |
| S0190 |
Mifepristone, oral, 200 mg |
61 |
61 |
$4K |
| Q3014 |
Telehealth originating site facility fee |
120 |
119 |
$3K |
| Q0111 |
Wet mounts, including preparations of vaginal, cervical or skin specimens |
525 |
523 |
$2K |
| 90674 |
|
65 |
65 |
$2K |
| 83986 |
|
524 |
522 |
$2K |
| 11981 |
|
13 |
12 |
$2K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
74 |
73 |
$1K |
| 99000 |
|
285 |
273 |
$473.33 |
| S0191 |
Misoprostol, oral, 200 mcg |
61 |
61 |
$194.37 |
| 85018 |
|
38 |
38 |
$82.41 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
53 |
53 |
$80.28 |
| 81002 |
|
30 |
30 |
$72.49 |
| S5000 |
Prescription drug, generic |
46 |
41 |
$0.00 |