| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99401 |
|
2,789 |
2,273 |
$76K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
3,644 |
3,034 |
$41K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
111 |
70 |
$7K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
216 |
204 |
$6K |
| 90734 |
|
206 |
182 |
$3K |
| 90686 |
|
337 |
321 |
$3K |
| 90674 |
|
127 |
96 |
$2K |
| 90715 |
|
113 |
111 |
$2K |
| 90670 |
|
231 |
223 |
$1K |
| 87210 |
|
274 |
225 |
$1K |
| 81025 |
|
405 |
329 |
$1K |
| 85018 |
|
210 |
180 |
$480.24 |
| 90698 |
|
77 |
70 |
$480.00 |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
1,116 |
799 |
$460.00 |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
611 |
570 |
$400.00 |
| 90716 |
|
12 |
12 |
$328.95 |
| 90633 |
|
48 |
44 |
$288.00 |
| 87808 |
|
25 |
25 |
$250.00 |
| G0008 |
Administration of influenza virus vaccine |
57 |
34 |
$211.20 |
| 90744 |
|
14 |
14 |
$89.60 |
| 90710 |
|
13 |
13 |
$83.20 |
| 90685 |
|
38 |
38 |
$76.80 |
| Q0144 |
Azithromycin dihydrate, oral, capsules/powder, 1 gram |
26 |
26 |
$0.00 |
| A4267 |
Contraceptive supply, condom, male, each |
195 |
99 |
$0.00 |
| 86592 |
|
595 |
468 |
$0.00 |
| 86701 |
|
548 |
428 |
$0.00 |