| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 96127 |
|
1,444 |
1,427 |
$85K |
| S4993 |
Contraceptive pills for birth control |
4,738 |
3,656 |
$70K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,686 |
1,186 |
$52K |
| G0451 |
Development testing, with interpretation and report, per standardized instrument form |
774 |
757 |
$44K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
581 |
413 |
$32K |
| H1003 |
Prenatal care, at-risk enhanced service; education |
746 |
673 |
$23K |
| H0046 |
Mental health services, not otherwise specified |
278 |
255 |
$9K |
| 96160 |
|
931 |
582 |
$6K |
| 99385 |
|
26 |
24 |
$2K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
129 |
99 |
$2K |
| 81025 |
|
268 |
178 |
$1K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
13 |
13 |
$1K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
65 |
44 |
$776.23 |
| A4267 |
Contraceptive supply, condom, male, each |
249 |
215 |
$546.72 |
| J7295 |
Ethinyl estradiol and etonogestrel 0.015mg, 0.12mg per 24 hours; monthly vaginal ring, each |
39 |
24 |
$395.83 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
59 |
40 |
$234.54 |
| J7303 |
Contraceptive supply, hormone containing vaginal ring, each |
12 |
12 |
$219.40 |