| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J7307 |
Etonogestrel (contraceptive) implant system, including implant and supplies |
70 |
70 |
$65K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,102 |
1,038 |
$60K |
| S4993 |
Contraceptive pills for birth control |
268 |
266 |
$53K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
996 |
971 |
$31K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
993 |
968 |
$30K |
| J3490 |
Unclassified drugs |
891 |
867 |
$25K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
306 |
303 |
$25K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
504 |
471 |
$17K |
| J7304 |
Contraceptive supply, hormone containing patch, each |
13 |
13 |
$16K |
| A4267 |
Contraceptive supply, condom, male, each |
652 |
631 |
$7K |
| 87806 |
|
197 |
195 |
$5K |
| 81025 |
|
1,523 |
1,410 |
$4K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
43 |
41 |
$4K |
| 90651 |
|
13 |
13 |
$4K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
26 |
26 |
$3K |
| 90674 |
|
83 |
83 |
$3K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
137 |
133 |
$3K |
| Q0111 |
Wet mounts, including preparations of vaginal, cervical or skin specimens |
473 |
467 |
$2K |
| S5000 |
Prescription drug, generic |
295 |
283 |
$2K |
| 83986 |
|
476 |
470 |
$1K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
173 |
167 |
$994.75 |
| 90746 |
|
12 |
12 |
$898.08 |
| 99000 |
|
186 |
183 |
$675.18 |
| 81002 |
|
169 |
165 |
$321.88 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
13 |
13 |
$201.24 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
12 |
12 |
$74.76 |