| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
7,353 |
7,353 |
$211K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
7,349 |
7,349 |
$211K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
2,732 |
1,938 |
$207K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
1,288 |
845 |
$181K |
| 86701 |
|
8,924 |
8,922 |
$66K |
| J7307 |
Etonogestrel (contraceptive) implant system, including implant and supplies |
71 |
71 |
$59K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
1,050 |
772 |
$57K |
| J3490 |
Unclassified drugs |
484 |
364 |
$50K |
| J7301 |
Levonorgestrel-releasing intrauterine contraceptive system (skyla), 13.5 mg |
68 |
34 |
$50K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,270 |
1,056 |
$50K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
219 |
158 |
$45K |
| Z1034 |
|
728 |
504 |
$40K |
| A4267 |
Contraceptive supply, condom, male, each |
2,958 |
2,936 |
$33K |
| 86592 |
|
8,984 |
8,982 |
$32K |
| Z1032 |
|
166 |
166 |
$26K |
| Z6500 |
|
147 |
147 |
$18K |
| S9445 |
Patient education, not otherwise classified, non-physician provider, individual, per session |
1,358 |
1,357 |
$17K |
| 59425 |
|
743 |
474 |
$15K |
| 11981 |
|
133 |
68 |
$15K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
296 |
278 |
$14K |
| 99381 |
|
136 |
122 |
$12K |
| 99402 |
|
286 |
286 |
$9K |
| 81025 |
|
2,642 |
2,637 |
$7K |
| 87340 |
|
813 |
813 |
$7K |
| 76801 |
|
124 |
111 |
$6K |
| 58300 |
|
66 |
34 |
$6K |
| 11976 |
|
95 |
49 |
$5K |
| Z6400 |
|
196 |
194 |
$3K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
494 |
486 |
$3K |
| 81002 |
|
1,348 |
960 |
$2K |
| Z6406 |
|
172 |
159 |
$2K |
| Z6204 |
|
164 |
151 |
$2K |
| Z6304 |
|
164 |
153 |
$1K |
| 99382 |
|
14 |
12 |
$1K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
173 |
172 |
$1K |
| Z6410 |
|
71 |
64 |
$1K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
67 |
63 |
$735.70 |
| S0197 |
Prenatal vitamins, 30-day supply |
373 |
206 |
$515.78 |
| 99215 |
Prolong outpt/office vis |
34 |
33 |
$378.93 |
| 92551 |
|
53 |
53 |
$374.68 |
| 90670 |
|
122 |
122 |
$351.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
57 |
57 |
$350.53 |
| 90744 |
|
65 |
65 |
$342.00 |
| 90698 |
|
60 |
60 |
$279.00 |
| 90680 |
|
67 |
67 |
$270.00 |
| 90713 |
|
43 |
43 |
$216.00 |
| 85018 |
|
198 |
198 |
$147.93 |
| 92552 |
|
40 |
40 |
$99.12 |
| 90700 |
|
77 |
77 |
$90.00 |
| 83655 |
|
46 |
46 |
$77.82 |
| 81000 |
|
94 |
94 |
$75.92 |
| 90647 |
|
33 |
33 |
$72.00 |
| 90633 |
|
69 |
68 |
$63.00 |
| 85014 |
|
67 |
67 |
$33.16 |
| 90657 |
|
12 |
12 |
$27.00 |
| 90710 |
|
12 |
12 |
$18.00 |
| 90674 |
|
27 |
27 |
$18.00 |
| 97803 |
|
48 |
41 |
$0.00 |
| H1003 |
Prenatal care, at-risk enhanced service; education |
72 |
54 |
$0.00 |
| 99401 |
|
72 |
62 |
$0.00 |
| 92081 |
|
14 |
14 |
$0.00 |