| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S9430 |
Pharmacy compounding and dispensing services |
1,270 |
1,246 |
$109K |
| S4993 |
Contraceptive pills for birth control |
1,434 |
1,179 |
$44K |
| 59899 |
|
198 |
184 |
$39K |
| 59840 |
|
72 |
65 |
$22K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
299 |
295 |
$19K |
| 01966 |
|
150 |
144 |
$12K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
102 |
93 |
$12K |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
219 |
201 |
$7K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
68 |
62 |
$6K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
12 |
12 |
$3K |
| 88300 |
|
199 |
185 |
$1K |
| S0190 |
Mifepristone, oral, 200 mg |
16 |
14 |
$670.00 |
| A4267 |
Contraceptive supply, condom, male, each |
171 |
169 |
$615.24 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
47 |
46 |
$573.43 |
| J3490 |
Unclassified drugs |
21 |
21 |
$482.09 |
| 86901 |
|
27 |
26 |
$171.82 |
| 85018 |
|
27 |
26 |
$51.92 |
| S0191 |
Misoprostol, oral, 200 mcg |
39 |
34 |
$39.90 |