| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
25,662 |
25,195 |
$753K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
25,594 |
25,140 |
$716K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
9,001 |
8,397 |
$495K |
| A4267 |
Contraceptive supply, condom, male, each |
11,740 |
11,187 |
$379K |
| S0199 |
Medically induced abortion by oral ingestion of medication including all associated services and supplies (e.g., patient counseling, office visits, confirmation of pregnancy by hcg, ultrasound to confirm duration of pregnancy, ultrasound to confirm completion of abortion) except drugs |
798 |
795 |
$343K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
8,892 |
8,420 |
$279K |
| 11981 |
|
877 |
874 |
$143K |
| 87806 |
|
7,418 |
7,356 |
$141K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
1,124 |
1,121 |
$117K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
3,667 |
3,571 |
$103K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
881 |
879 |
$78K |
| 81025 |
|
25,084 |
23,071 |
$59K |
| 11976 |
|
1,234 |
667 |
$56K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
756 |
621 |
$53K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
999 |
998 |
$48K |
| 58300 |
|
575 |
303 |
$44K |
| 90651 |
|
165 |
165 |
$33K |
| S4993 |
Contraceptive pills for birth control |
722 |
715 |
$33K |
| S0190 |
Mifepristone, oral, 200 mg |
608 |
608 |
$29K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
1,113 |
1,091 |
$24K |
| 99000 |
|
6,936 |
6,640 |
$20K |
| Q0111 |
Wet mounts, including preparations of vaginal, cervical or skin specimens |
4,833 |
4,650 |
$15K |
| J7307 |
Etonogestrel (contraceptive) implant system, including implant and supplies |
14 |
14 |
$12K |
| 83986 |
|
4,843 |
4,659 |
$11K |
| 59840 |
|
16 |
12 |
$5K |
| 58301 |
|
237 |
118 |
$4K |
| Q3014 |
Telehealth originating site facility fee |
341 |
339 |
$4K |
| 90674 |
|
188 |
188 |
$3K |
| 81002 |
|
1,481 |
1,418 |
$2K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
538 |
532 |
$2K |
| S5000 |
Prescription drug, generic |
960 |
779 |
$1K |
| S0191 |
Misoprostol, oral, 200 mcg |
481 |
471 |
$1K |
| 99201 |
|
40 |
40 |
$856.48 |
| J3490 |
Unclassified drugs |
274 |
257 |
$806.74 |
| 85018 |
|
301 |
285 |
$374.45 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
295 |
294 |
$305.61 |
| G0444 |
Annual depression screening, 5 to 15 minutes |
30 |
29 |
$242.40 |
| 86901 |
|
79 |
79 |
$189.38 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
109 |
108 |
$42.70 |
| G8783 |
Normal blood pressure reading documented, follow-up not required |
114 |
110 |
$0.00 |