| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
648 |
614 |
$44K |
| 99215 |
Prolong outpt/office vis |
721 |
710 |
$41K |
| 99000 |
|
2,391 |
2,271 |
$22K |
| S4993 |
Contraceptive pills for birth control |
231 |
225 |
$21K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
2,152 |
1,939 |
$19K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
2,629 |
1,169 |
$19K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
662 |
631 |
$17K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
229 |
229 |
$14K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
783 |
760 |
$9K |
| 99385 |
|
91 |
91 |
$6K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
74 |
65 |
$4K |
| 81025 |
|
593 |
558 |
$3K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
271 |
258 |
$3K |
| 81003 |
|
1,862 |
1,769 |
$2K |
| 90651 |
|
205 |
194 |
$2K |
| 99001 |
|
154 |
135 |
$841.59 |
| 87210 |
|
115 |
112 |
$537.90 |
| A4267 |
Contraceptive supply, condom, male, each |
57 |
55 |
$499.16 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
27 |
26 |
$453.87 |
| 81000 |
|
124 |
121 |
$412.36 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
14 |
12 |
$384.27 |
| 81002 |
|
109 |
108 |
$286.16 |
| 90713 |
|
199 |
192 |
$87.04 |
| 90715 |
|
256 |
239 |
$65.28 |
| 86780 |
|
45 |
45 |
$20.00 |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
59 |
58 |
$20.00 |
| 90734 |
|
283 |
265 |
$13.00 |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
59 |
57 |
$10.00 |
| 86762 |
|
30 |
30 |
$10.00 |
| 85027 |
|
36 |
36 |
$5.43 |
| 90686 |
|
168 |
165 |
$4.01 |
| 90633 |
|
338 |
314 |
$0.00 |
| 88175 |
Cytopathology, cervical or vaginal, any reporting system; collected in preservative fluid, automated thin layer |
17 |
17 |
$0.00 |
| 90700 |
|
14 |
14 |
$0.00 |
| 80061 |
Lipid panel |
14 |
14 |
$0.00 |
| 90707 |
|
14 |
14 |
$0.00 |
| 90716 |
|
213 |
206 |
$0.00 |
| Q2035 |
Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (afluria) |
60 |
57 |
$0.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
14 |
14 |
$0.00 |
| 87624 |
Infectious agent detection by nucleic acid; human papillomavirus (HPV), high-risk types |
13 |
13 |
$0.00 |
| 90619 |
|
64 |
56 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
93 |
92 |
$0.00 |
| 90677 |
|
21 |
14 |
$0.00 |
| 80053 |
Comprehensive metabolic panel |
14 |
14 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
14 |
14 |
$0.00 |