| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
2,864 |
2,562 |
$251K |
| H1010 |
Non-medical family planning education, per session |
6,982 |
6,153 |
$158K |
| A4268 |
Contraceptive supply, condom, female, each |
4,587 |
3,802 |
$100K |
| S4993 |
Contraceptive pills for birth control |
2,020 |
1,789 |
$79K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
4,397 |
3,970 |
$58K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
477 |
435 |
$27K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
473 |
434 |
$18K |
| 81025 |
|
3,185 |
2,821 |
$18K |
| A4267 |
Contraceptive supply, condom, male, each |
1,771 |
1,602 |
$12K |
| J8499 |
Prescription drug, oral, non chemotherapeutic, nos |
321 |
274 |
$9K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
76 |
69 |
$3K |
| 99406 |
|
87 |
66 |
$782.69 |
| D1208 |
Topical application of fluoride, excluding varnish |
26 |
26 |
$378.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$332.04 |
| 99441 |
|
27 |
27 |
$302.40 |
| D0120 |
Periodic oral evaluation - established patient |
13 |
13 |
$233.09 |