| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,129 |
978 |
$80K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
435 |
403 |
$49K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
986 |
876 |
$48K |
| J7297 |
Levonorgestrel-releasing intrauterine contraceptive system (liletta), 52 mg |
25 |
12 |
$9K |
| 87210 |
|
430 |
388 |
$2K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
22 |
14 |
$1K |
| 58300 |
|
25 |
12 |
$709.68 |