| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
249 |
235 |
$8K |
| 81025 |
|
867 |
782 |
$3K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
43 |
43 |
$3K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
45 |
41 |
$2K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
28 |
27 |
$1K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
47 |
43 |
$1K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
106 |
101 |
$760.26 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
27 |
27 |
$549.04 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
81 |
80 |
$423.24 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
28 |
27 |
$226.15 |
| 90686 |
|
16 |
16 |
$156.05 |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
70 |
68 |
$51.54 |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
71 |
69 |
$51.54 |
| 87660 |
|
67 |
65 |
$29.44 |
| 88175 |
Cytopathology, cervical or vaginal, any reporting system; collected in preservative fluid, automated thin layer |
71 |
71 |
$19.53 |
| A4267 |
Contraceptive supply, condom, male, each |
14 |
14 |
$4.75 |
| 86592 |
|
139 |
135 |
$3.14 |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
137 |
134 |
$0.00 |
| 84443 |
Thyroid stimulating hormone (TSH) |
125 |
121 |
$0.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
124 |
121 |
$0.00 |
| G0433 |
Infectious agent antibody detection by enzyme-linked immunosorbent assay (elisa) technique, hiv-1 and/or hiv-2, screening |
56 |
56 |
$0.00 |
| 96127 |
|
74 |
69 |
$0.00 |
| 86762 |
|
12 |
12 |
$0.00 |
| 80061 |
Lipid panel |
136 |
133 |
$0.00 |
| S4993 |
Contraceptive pills for birth control |
13 |
12 |
$0.00 |
| 90655 |
|
26 |
26 |
$0.00 |
| 83655 |
|
14 |
14 |
$0.00 |