| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S9430 |
Pharmacy compounding and dispensing services |
2,417 |
2,314 |
$217K |
| S4993 |
Contraceptive pills for birth control |
1,717 |
1,220 |
$50K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
548 |
528 |
$24K |
| J3490 |
Unclassified drugs |
1,522 |
1,120 |
$22K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
71 |
70 |
$6K |
| 81025 |
|
533 |
526 |
$3K |
| Q3014 |
Telehealth originating site facility fee |
124 |
124 |
$3K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
28 |
28 |
$2K |
| 99385 |
|
18 |
18 |
$2K |
| A4267 |
Contraceptive supply, condom, male, each |
274 |
268 |
$1K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
75 |
75 |
$751.50 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
14 |
14 |
$607.04 |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
188 |
175 |
$569.35 |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
13 |
13 |
$353.34 |
| 86780 |
|
22 |
22 |
$304.92 |
| 86703 |
|
19 |
19 |
$258.30 |
| 87210 |
|
18 |
18 |
$98.64 |
| 83986 |
|
17 |
17 |
$63.75 |