| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
921 |
763 |
$62K |
| 99401 |
|
2,056 |
1,477 |
$55K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
1,297 |
992 |
$52K |
| 87806 |
|
1,897 |
1,570 |
$36K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
349 |
284 |
$25K |
| J7307 |
Etonogestrel (contraceptive) implant system, including implant and supplies |
13 |
13 |
$15K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
1,130 |
773 |
$11K |
| J8499 |
Prescription drug, oral, non chemotherapeutic, nos |
287 |
263 |
$10K |
| 81025 |
|
2,477 |
1,826 |
$10K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
180 |
154 |
$9K |
| 76830 |
Ultrasound, transvaginal |
89 |
84 |
$6K |
| 87210 |
|
685 |
545 |
$3K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
27 |
26 |
$2K |
| S4993 |
Contraceptive pills for birth control |
47 |
41 |
$2K |
| 83986 |
|
434 |
332 |
$1K |
| 85018 |
|
387 |
303 |
$874.64 |
| 86901 |
|
145 |
131 |
$676.80 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
39 |
34 |
$489.58 |
| A4267 |
Contraceptive supply, condom, male, each |
25 |
13 |
$334.49 |