| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
677 |
658 |
$48K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,766 |
1,691 |
$45K |
| S4993 |
Contraceptive pills for birth control |
497 |
490 |
$33K |
| J7295 |
Ethinyl estradiol and etonogestrel 0.015mg, 0.12mg per 24 hours; monthly vaginal ring, each |
38 |
38 |
$19K |
| J7303 |
Contraceptive supply, hormone containing vaginal ring, each |
39 |
39 |
$16K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
675 |
661 |
$8K |
| G0433 |
Infectious agent antibody detection by enzyme-linked immunosorbent assay (elisa) technique, hiv-1 and/or hiv-2, screening |
452 |
448 |
$6K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
129 |
126 |
$5K |
| 81025 |
|
513 |
502 |
$4K |
| A9150 |
Non-prescription drugs |
82 |
81 |
$863.80 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
22 |
22 |
$401.94 |
| A4267 |
Contraceptive supply, condom, male, each |
14 |
14 |
$38.08 |
| S5000 |
Prescription drug, generic |
26 |
25 |
$0.00 |