| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
170 |
169 |
$8K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
170 |
169 |
$8K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
53 |
51 |
$4K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
24 |
24 |
$2K |
| 86780 |
|
90 |
90 |
$2K |
| 59025 |
Fetal non-stress test |
23 |
12 |
$1K |
| 88175 |
Cytopathology, cervical or vaginal, any reporting system; collected in preservative fluid, automated thin layer |
24 |
24 |
$876.00 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
25 |
25 |
$603.16 |
| 85027 |
|
61 |
61 |
$535.26 |
| 86803 |
|
24 |
24 |
$463.92 |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
12 |
12 |
$384.84 |
| 87340 |
|
24 |
24 |
$335.76 |
| 82565 |
|
12 |
12 |
$81.96 |