| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
|
9,102 |
8,595 |
$586K |
| 99214 |
|
6,750 |
6,198 |
$443K |
| 99202 |
|
2,128 |
2,125 |
$292K |
| S4993 |
Contraceptive pills for bc |
2,155 |
2,145 |
$248K |
| S0199 |
Med abortion inc all ex drug |
321 |
319 |
$232K |
| J3490 |
Drugs unclassified injection |
6,226 |
5,250 |
$225K |
| 87806 |
|
6,781 |
5,875 |
$173K |
| 99212 |
|
2,997 |
2,908 |
$167K |
| 99203 |
|
587 |
587 |
$122K |
| 99211 |
|
3,894 |
3,625 |
$116K |
| J7307 |
Etonogestrel implant system |
117 |
117 |
$97K |
| 99204 |
|
354 |
354 |
$77K |
| 99201 |
|
744 |
740 |
$72K |
| 90837 |
|
610 |
285 |
$48K |
| 58300 |
|
423 |
212 |
$47K |
| A4267 |
Male condom |
3,832 |
3,812 |
$41K |
| 90834 |
|
498 |
286 |
$35K |
| T1999 |
Noc retail items andsupplies |
2,575 |
1,931 |
$32K |
| J7298 |
Mirena, 52 mg |
40 |
40 |
$29K |
| 99401 |
|
1,511 |
1,456 |
$29K |
| 87661 |
|
824 |
819 |
$25K |
| 99000 |
|
6,807 |
6,672 |
$25K |
| 11981 |
|
95 |
95 |
$22K |
| 99402 |
|
632 |
625 |
$20K |
| S0190 |
Mifepristone, oral, 200 mg |
330 |
329 |
$19K |
| 76815 |
|
178 |
172 |
$16K |
| J7303 |
Contraceptive vaginal ring |
65 |
65 |
$16K |
| 81025 |
|
3,751 |
3,724 |
$11K |
| 11976 |
|
189 |
105 |
$11K |
| S9445 |
Pt education noc individ |
802 |
802 |
$10K |
| Q0111 |
Wet mounts/ w preparations |
2,659 |
2,600 |
$10K |
| 83986 |
|
3,391 |
2,974 |
$10K |
| J7300 |
Intra copp contra (paragard) |
12 |
12 |
$8K |
| J7304 |
Contraceptive hormone patch |
14 |
14 |
$6K |
| S5000 |
Prescription drug, generic |
891 |
849 |
$6K |
| Q3014 |
Telehealth facility fee |
268 |
220 |
$6K |
| 90651 |
|
26 |
26 |
$5K |
| 58301 |
|
119 |
63 |
$4K |
| 99395 |
|
79 |
79 |
$4K |
| G2012 |
Brief check in by md/qhp |
220 |
211 |
$3K |
| 90686 |
|
96 |
96 |
$2K |
| 81002 |
|
974 |
958 |
$2K |
| T1014 |
Telehealth transmit, per min |
268 |
219 |
$2K |
| S0191 |
Misoprostol, oral, 200 mcg |
415 |
406 |
$1K |
| Q0144 |
Azithromycin dihydrate, oral |
231 |
226 |
$1K |
| 90832 |
|
14 |
12 |
$949.62 |
| 99215 |
Prolong outpt/office vis |
12 |
12 |
$685.36 |
| 99396 |
|
127 |
125 |
$613.36 |
| 85018 |
|
227 |
221 |
$542.78 |
| 90630 |
|
15 |
15 |
$358.40 |
| 86901 |
|
12 |
12 |
$39.84 |
| 3078F |
|
1,902 |
1,808 |
$0.00 |
| 3077F |
|
31 |
29 |
$0.00 |
| 3074F |
|
1,679 |
1,604 |
$0.00 |
| 3079F |
|
39 |
38 |
$0.00 |
| 3075F |
|
78 |
76 |
$0.00 |