| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 58300 |
|
193 |
153 |
$17K |
| J7307 |
Etonogestrel (contraceptive) implant system, including implant and supplies |
16 |
12 |
$17K |
| 87806 |
|
647 |
569 |
$13K |
| S4993 |
Contraceptive pills for birth control |
234 |
212 |
$11K |
| 99401 |
|
409 |
278 |
$10K |
| J7297 |
Levonorgestrel-releasing intrauterine contraceptive system (liletta), 52 mg |
87 |
80 |
$10K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
120 |
80 |
$5K |
| 99232 |
Subsequent hospital care, per day, moderate complexity |
61 |
56 |
$2K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
69 |
65 |
$2K |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
25 |
25 |
$2K |
| 11981 |
|
16 |
12 |
$1K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
89 |
60 |
$696.51 |
| 99070 |
|
14 |
12 |
$294.00 |
| S0191 |
Misoprostol, oral, 200 mcg |
20 |
18 |
$0.00 |