| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| H1010 |
Non-medical family planning education, per session |
15,757 |
14,357 |
$1.50M |
| S4993 |
Contraceptive pills for birth control |
13,250 |
7,170 |
$976K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
4,728 |
4,476 |
$147K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,761 |
2,673 |
$139K |
| J8499 |
Prescription drug, oral, non chemotherapeutic, nos |
3,664 |
3,021 |
$105K |
| A4267 |
Contraceptive supply, condom, male, each |
7,870 |
7,510 |
$99K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
3,386 |
3,333 |
$58K |
| 87806 |
|
2,136 |
2,084 |
$54K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
1,327 |
1,291 |
$46K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
489 |
478 |
$40K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
696 |
683 |
$39K |
| 81025 |
|
3,296 |
3,198 |
$28K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
2,055 |
2,026 |
$25K |
| 99000 |
|
6,906 |
6,599 |
$25K |
| 87210 |
|
2,910 |
2,833 |
$17K |
| Q0144 |
Azithromycin dihydrate, oral, capsules/powder, 1 gram |
611 |
579 |
$11K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
477 |
453 |
$11K |
| 86703 |
|
375 |
373 |
$5K |
| 81002 |
|
694 |
665 |
$2K |
| Q3014 |
Telehealth originating site facility fee |
79 |
78 |
$2K |
| J3490 |
Unclassified drugs |
108 |
108 |
$1K |
| 99201 |
|
49 |
47 |
$1K |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
31 |
30 |
$15.90 |