| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S4993 |
Contraceptive pills for birth control |
3,781 |
2,762 |
$294K |
| H1010 |
Non-medical family planning education, per session |
3,755 |
3,360 |
$285K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
756 |
671 |
$47K |
| A4267 |
Contraceptive supply, condom, male, each |
1,415 |
1,274 |
$24K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
346 |
318 |
$18K |
| S5170 |
Home delivered meals, including preparation; per meal |
73 |
71 |
$18K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
442 |
405 |
$10K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
93 |
92 |
$5K |
| 91322 |
|
39 |
36 |
$5K |
| 99000 |
|
1,335 |
1,216 |
$4K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
375 |
338 |
$4K |
| 90686 |
|
234 |
213 |
$4K |
| 0012A |
|
211 |
104 |
$2K |
| 90480 |
|
53 |
50 |
$2K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
14 |
14 |
$1K |
| 0011A |
|
253 |
119 |
$1K |
| 90656 |
|
26 |
26 |
$548.24 |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
13 |
12 |
$385.99 |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
13 |
12 |
$385.99 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
130 |
107 |
$344.40 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
12 |
12 |
$317.64 |
| 81025 |
|
14 |
12 |
$111.93 |
| 36416 |
|
14 |
12 |
$30.30 |
| 91301 |
|
539 |
247 |
$0.00 |