| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S4993 |
Contraceptive pills for birth control |
772 |
756 |
$121K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
1,417 |
1,402 |
$91K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
3,073 |
2,463 |
$81K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
3,079 |
2,464 |
$81K |
| 99385 |
|
1,049 |
1,031 |
$75K |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
3,454 |
3,366 |
$56K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
685 |
676 |
$47K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,516 |
1,418 |
$41K |
| A4269 |
Contraceptive supply, spermicide (e.g., foam, gel), each |
148 |
144 |
$31K |
| J7307 |
Etonogestrel (contraceptive) implant system, including implant and supplies |
38 |
37 |
$23K |
| 81025 |
|
3,431 |
3,273 |
$23K |
| A9150 |
Non-prescription drugs |
1,033 |
817 |
$12K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
778 |
760 |
$10K |
| A4267 |
Contraceptive supply, condom, male, each |
696 |
658 |
$7K |
| 87210 |
|
1,208 |
1,161 |
$6K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
339 |
330 |
$3K |
| 80061 |
Lipid panel |
430 |
425 |
$2K |
| 81002 |
|
704 |
687 |
$2K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
89 |
88 |
$2K |
| 82947 |
|
432 |
427 |
$2K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
118 |
112 |
$1K |
| 11981 |
|
12 |
12 |
$1K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
27 |
26 |
$1K |
| 85018 |
|
154 |
151 |
$295.18 |
| 88142 |
|
14 |
14 |
$153.18 |
| 86592 |
|
63 |
56 |
$95.13 |
| 85014 |
|
12 |
12 |
$7.16 |
| S5000 |
Prescription drug, generic |
149 |
127 |
$0.00 |
| J8499 |
Prescription drug, oral, non chemotherapeutic, nos |
15 |
15 |
$0.00 |