| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S4993 |
Contraceptive pills for birth control |
683 |
523 |
$37K |
| H1010 |
Non-medical family planning education, per session |
690 |
642 |
$31K |
| A4267 |
Contraceptive supply, condom, male, each |
378 |
353 |
$5K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
165 |
157 |
$5K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
172 |
154 |
$4K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
202 |
193 |
$2K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
109 |
100 |
$2K |
| 99000 |
|
1,052 |
500 |
$2K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
41 |
39 |
$2K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
29 |
28 |
$2K |
| 81000 |
|
383 |
361 |
$1K |
| 81025 |
|
170 |
157 |
$1K |
| 99385 |
|
13 |
13 |
$683.52 |
| A4268 |
Contraceptive supply, condom, female, each |
139 |
133 |
$260.00 |
| 87210 |
|
41 |
32 |
$180.11 |
| 36415 |
Collection of venous blood by venipuncture |
115 |
106 |
$0.00 |