| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J7307 |
Etonogestrel (contraceptive) implant system, including implant and supplies |
1,287 |
1,272 |
$1.06M |
| S4993 |
Contraceptive pills for birth control |
3,666 |
3,581 |
$689K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
14,023 |
13,729 |
$624K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
14,027 |
13,731 |
$607K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
9,569 |
8,529 |
$518K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
12,987 |
10,989 |
$413K |
| J7304 |
Contraceptive supply, hormone containing patch, each |
383 |
364 |
$336K |
| 90651 |
|
1,139 |
1,114 |
$265K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
3,755 |
3,547 |
$254K |
| 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 |
318 |
314 |
$184K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
1,456 |
1,348 |
$138K |
| J3490 |
Unclassified drugs |
5,295 |
5,013 |
$131K |
| A4267 |
Contraceptive supply, condom, male, each |
10,996 |
10,460 |
$129K |
| 11981 |
|
530 |
515 |
$105K |
| 87806 |
|
4,091 |
4,036 |
$87K |
| 11976 |
|
1,244 |
610 |
$80K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
2,668 |
2,412 |
$69K |
| 90674 |
|
1,750 |
1,699 |
$53K |
| 81025 |
|
17,976 |
16,642 |
$53K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
475 |
464 |
$48K |
| Q3014 |
Telehealth originating site facility fee |
2,697 |
2,503 |
$47K |
| 96156 |
|
675 |
650 |
$45K |
| 58300 |
|
398 |
196 |
$43K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
451 |
368 |
$32K |
| 99385 |
|
180 |
160 |
$16K |
| S0190 |
Mifepristone, oral, 200 mg |
226 |
223 |
$16K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
323 |
265 |
$15K |
| J7298 |
Levonorgestrel-releasing intrauterine contraceptive system (mirena), 52 mg |
14 |
14 |
$12K |
| J7303 |
Contraceptive supply, hormone containing vaginal ring, each |
62 |
61 |
$12K |
| Q0111 |
Wet mounts, including preparations of vaginal, cervical or skin specimens |
2,865 |
2,790 |
$11K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
695 |
657 |
$11K |
| 83986 |
|
2,867 |
2,792 |
$9K |
| 99000 |
|
3,134 |
3,060 |
$8K |
| 58301 |
|
257 |
115 |
$8K |
| Q0144 |
Azithromycin dihydrate, oral, capsules/powder, 1 gram |
1,437 |
1,401 |
$7K |
| 90715 |
|
139 |
138 |
$6K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
2,571 |
2,481 |
$5K |
| 81002 |
|
1,545 |
1,497 |
$3K |
| G8431 |
Screening for depression is documented as being positive and a follow-up plan is documented |
240 |
237 |
$3K |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
507 |
489 |
$3K |
| 96150 |
|
251 |
250 |
$2K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
915 |
906 |
$2K |
| 96127 |
|
494 |
473 |
$2K |
| 86580 |
|
138 |
132 |
$1K |
| U0003 |
Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high throughput technologies as described by cms-2020-01-r |
14 |
13 |
$1K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
12 |
12 |
$1K |
| 90746 |
|
12 |
12 |
$886.40 |
| S0191 |
Misoprostol, oral, 200 mcg |
230 |
224 |
$794.20 |
| G0442 |
Annual alcohol misuse screening, 5 to 15 minutes |
106 |
105 |
$548.28 |
| 85018 |
|
637 |
623 |
$532.59 |
| G0444 |
Annual depression screening, 5 to 15 minutes |
64 |
61 |
$170.19 |
| 87430 |
|
12 |
12 |
$130.95 |
| 96151 |
|
31 |
31 |
$48.66 |
| S5001 |
Prescription drug, brand name |
392 |
391 |
$1.18 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
397 |
397 |
$1.05 |
| 3078F |
|
797 |
797 |
$0.00 |
| S5000 |
Prescription drug, generic |
2,834 |
2,263 |
$0.00 |
| 1160F |
|
1,181 |
1,181 |
$0.00 |
| 1159F |
|
1,181 |
1,181 |
$0.00 |
| G8783 |
Normal blood pressure reading documented, follow-up not required |
129 |
126 |
$0.00 |
| G8417 |
Bmi is documented above normal parameters and a follow-up plan is documented |
37 |
37 |
$0.00 |
| 99442 |
|
60 |
52 |
$0.00 |
| 2000F |
|
842 |
841 |
$0.00 |
| 3074F |
|
833 |
833 |
$0.00 |
| 1036F |
|
929 |
929 |
$0.00 |
| 3008F |
|
552 |
552 |
$0.00 |
| 99441 |
|
13 |
13 |
$0.00 |