| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S9430 |
Pharmacy compounding and dispensing services |
54,834 |
51,930 |
$5.40M |
| S4993 |
Contraceptive pills for birth control |
78,918 |
59,002 |
$2.50M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
27,048 |
26,062 |
$1.96M |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
12,237 |
11,714 |
$1.79M |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
14,057 |
13,566 |
$1.71M |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
11,256 |
10,855 |
$676K |
| 81025 |
|
38,220 |
36,855 |
$542K |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
18,340 |
18,066 |
$383K |
| 99385 |
|
2,206 |
2,136 |
$366K |
| J7307 |
Etonogestrel (contraceptive) implant system, including implant and supplies |
903 |
879 |
$346K |
| J7304 |
Contraceptive supply, hormone containing patch, each |
495 |
432 |
$311K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
4,398 |
4,329 |
$283K |
| 58300 |
|
627 |
611 |
$215K |
| 11981 |
|
644 |
629 |
$207K |
| 86780 |
|
16,570 |
16,284 |
$189K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
12,878 |
12,349 |
$174K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
8,331 |
8,153 |
$127K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
1,093 |
1,066 |
$125K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
425 |
417 |
$86K |
| 90834 |
Psychotherapy, 45 minutes with patient |
1,527 |
819 |
$86K |
| 87210 |
|
12,673 |
12,378 |
$63K |
| J3490 |
Unclassified drugs |
3,852 |
2,817 |
$51K |
| 83986 |
|
12,544 |
12,208 |
$39K |
| Q3014 |
Telehealth originating site facility fee |
3,277 |
3,112 |
$29K |
| 99384 |
|
144 |
134 |
$25K |
| 11982 |
|
343 |
338 |
$24K |
| H0020 |
Alcohol and/or drug services; methadone administration and/or service (provision of the drug by a licensed program) |
93 |
79 |
$19K |
| A4267 |
Contraceptive supply, condom, male, each |
4,744 |
4,521 |
$18K |
| 58301 |
|
270 |
262 |
$16K |
| 86803 |
|
1,197 |
1,185 |
$15K |
| J7295 |
Ethinyl estradiol and etonogestrel 0.015mg, 0.12mg per 24 hours; monthly vaginal ring, each |
38 |
34 |
$11K |
| 99215 |
Prolong outpt/office vis |
111 |
106 |
$10K |
| 81002 |
|
3,168 |
3,094 |
$9K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
1,232 |
1,173 |
$8K |
| 96156 |
|
117 |
116 |
$8K |
| 86703 |
|
472 |
465 |
$7K |
| J7298 |
Levonorgestrel-releasing intrauterine contraceptive system (mirena), 52 mg |
25 |
25 |
$6K |
| 90651 |
|
27 |
26 |
$6K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
45 |
44 |
$3K |
| A4268 |
Contraceptive supply, condom, female, each |
251 |
246 |
$2K |
| 36415 |
Collection of venous blood by venipuncture |
205 |
203 |
$2K |
| 36416 |
|
387 |
378 |
$2K |
| 87808 |
|
112 |
111 |
$1K |
| 57454 |
|
12 |
12 |
$1K |
| 90688 |
|
50 |
46 |
$829.37 |
| A4269 |
Contraceptive supply, spermicide (e.g., foam, gel), each |
143 |
135 |
$685.50 |
| 0012A |
|
14 |
14 |
$524.80 |
| 88305 |
Level IV - Surgical pathology, gross and microscopic examination |
12 |
12 |
$329.61 |
| 85018 |
|
120 |
110 |
$234.33 |
| J7303 |
Contraceptive supply, hormone containing vaginal ring, each |
25 |
24 |
$2.55 |
| 87661 |
Infectious agent detection by nucleic acid; Trichomonas vaginalis, amplified probe |
46 |
46 |
$0.00 |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
329 |
291 |
$0.00 |