| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J3490 |
Unclassified drugs |
16,486 |
14,394 |
$872K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
8,600 |
8,147 |
$780K |
| S4993 |
Contraceptive pills for birth control |
6,888 |
6,612 |
$766K |
| J7307 |
Etonogestrel (contraceptive) implant system, including implant and supplies |
633 |
631 |
$670K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
3,884 |
3,747 |
$529K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
7,413 |
7,158 |
$482K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
3,579 |
3,478 |
$449K |
| 87806 |
|
16,499 |
14,131 |
$405K |
| S0199 |
Medically induced abortion by oral ingestion of medication including all associated services and supplies (e.g., patient counseling, office visits, confirmation of pregnancy by hcg, ultrasound to confirm duration of pregnancy, ultrasound to confirm completion of abortion) except drugs |
698 |
698 |
$353K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
1,589 |
1,570 |
$332K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
7,008 |
6,572 |
$326K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
1,170 |
1,167 |
$265K |
| A4267 |
Contraceptive supply, condom, male, each |
9,944 |
9,833 |
$236K |
| 90651 |
|
1,012 |
1,008 |
$218K |
| 11981 |
|
638 |
636 |
$174K |
| 58300 |
|
1,176 |
637 |
$149K |
| 99201 |
|
1,601 |
1,554 |
$143K |
| J7298 |
Levonorgestrel-releasing intrauterine contraceptive system (mirena), 52 mg |
164 |
163 |
$138K |
| J7304 |
Contraceptive supply, hormone containing patch, each |
186 |
185 |
$127K |
| 81025 |
|
12,259 |
11,970 |
$65K |
| 11976 |
|
841 |
462 |
$55K |
| S0190 |
Mifepristone, oral, 200 mg |
676 |
675 |
$40K |
| S5199 |
Personal care item, nos, each |
8,089 |
8,037 |
$35K |
| S9445 |
Patient education, not otherwise classified, non-physician provider, individual, per session |
1,982 |
1,982 |
$25K |
| J7303 |
Contraceptive supply, hormone containing vaginal ring, each |
74 |
70 |
$22K |
| 99000 |
|
7,295 |
7,199 |
$22K |
| 83986 |
|
5,402 |
4,593 |
$15K |
| S5000 |
Prescription drug, generic |
2,280 |
2,052 |
$14K |
| 58301 |
|
338 |
191 |
$14K |
| Q0111 |
Wet mounts, including preparations of vaginal, cervical or skin specimens |
2,675 |
2,619 |
$10K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
161 |
160 |
$8K |
| 82120 |
|
2,085 |
1,990 |
$8K |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
65 |
65 |
$4K |
| 87210 |
|
1,067 |
1,057 |
$4K |
| Q0144 |
Azithromycin dihydrate, oral, capsules/powder, 1 gram |
493 |
401 |
$3K |
| 81002 |
|
980 |
958 |
$2K |
| S0191 |
Misoprostol, oral, 200 mcg |
532 |
522 |
$2K |
| 99401 |
|
80 |
77 |
$2K |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
44 |
44 |
$217.29 |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
469 |
467 |
$186.72 |
| 85018 |
|
94 |
93 |
$169.42 |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
469 |
467 |
$0.00 |