| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J3490 |
Unclassified drugs |
287 |
243 |
$24K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
222 |
108 |
$16K |
| S9445 |
Patient education, not otherwise classified, non-physician provider, individual, per session |
897 |
897 |
$11K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
194 |
97 |
$10K |
| 99201 |
|
59 |
30 |
$5K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
44 |
20 |
$4K |
| 99000 |
|
1,064 |
1,061 |
$4K |
| 99401 |
|
52 |
52 |
$989.49 |
| A4267 |
Contraceptive supply, condom, male, each |
455 |
442 |
$820.84 |
| S5199 |
Personal care item, nos, each |
452 |
439 |
$99.72 |
| 81025 |
|
13 |
13 |
$36.40 |