| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| H1010 |
Non-medical family planning education, per session |
4,466 |
3,739 |
$326K |
| S4993 |
Contraceptive pills for birth control |
3,544 |
2,647 |
$214K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
565 |
522 |
$27K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
611 |
545 |
$18K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
572 |
506 |
$17K |
| A4267 |
Contraceptive supply, condom, male, each |
1,034 |
874 |
$14K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
54 |
54 |
$5K |
| 99000 |
|
1,320 |
1,085 |
$4K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
78 |
78 |
$2K |
| A4268 |
Contraceptive supply, condom, female, each |
250 |
213 |
$1K |
| 81025 |
|
92 |
85 |
$749.07 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
17 |
12 |
$724.56 |
| 81002 |
|
92 |
87 |
$309.72 |
| 87210 |
|
14 |
13 |
$75.53 |
| J8499 |
Prescription drug, oral, non chemotherapeutic, nos |
15 |
12 |
$23.16 |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
405 |
272 |
$0.00 |
| 99441 |
|
19 |
12 |
$0.00 |
| 87661 |
Infectious agent detection by nucleic acid; Trichomonas vaginalis, amplified probe |
13 |
12 |
$0.00 |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
407 |
274 |
$0.00 |