| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
392 |
372 |
$31K |
| 87806 |
|
552 |
523 |
$11K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
345 |
315 |
$11K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
151 |
131 |
$7K |
| J8499 |
Prescription drug, oral, non chemotherapeutic, nos |
92 |
85 |
$3K |
| 81025 |
|
681 |
606 |
$3K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
192 |
175 |
$2K |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
14 |
14 |
$1K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
13 |
12 |
$934.70 |
| 87210 |
|
187 |
179 |
$743.76 |
| 99401 |
|
13 |
13 |
$390.00 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
19 |
17 |
$243.56 |
| A4267 |
Contraceptive supply, condom, male, each |
12 |
12 |
$111.74 |