| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J7307 |
Etonogestrel (contraceptive) implant system, including implant and supplies |
756 |
736 |
$615K |
| S4993 |
Contraceptive pills for birth control |
2,465 |
2,420 |
$485K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
5,785 |
5,387 |
$370K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
7,237 |
7,098 |
$290K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
7,228 |
7,088 |
$276K |
| J7304 |
Contraceptive supply, hormone containing patch, each |
180 |
179 |
$182K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
5,437 |
5,102 |
$170K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
2,355 |
2,207 |
$160K |
| J3490 |
Unclassified drugs |
5,688 |
5,449 |
$145K |
| S0199 |
Medically induced abortion by oral ingestion of medication including all associated services and supplies (e.g., patient counseling, office visits, confirmation of pregnancy by hcg, ultrasound to confirm duration of pregnancy, ultrasound to confirm completion of abortion) except drugs |
185 |
178 |
$107K |
| A4267 |
Contraceptive supply, condom, male, each |
5,209 |
5,013 |
$59K |
| 87806 |
|
2,070 |
2,051 |
$47K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,500 |
1,430 |
$42K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
279 |
277 |
$34K |
| 11981 |
|
158 |
146 |
$27K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
281 |
274 |
$26K |
| 11976 |
|
486 |
234 |
$25K |
| 81025 |
|
8,620 |
8,111 |
$24K |
| Q3014 |
Telehealth originating site facility fee |
1,326 |
1,256 |
$22K |
| 96156 |
|
309 |
302 |
$20K |
| 58300 |
|
196 |
97 |
$16K |
| 90674 |
|
511 |
503 |
$16K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
179 |
151 |
$13K |
| 90651 |
|
50 |
50 |
$13K |
| S0190 |
Mifepristone, oral, 200 mg |
167 |
164 |
$12K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
114 |
111 |
$10K |
| Q0111 |
Wet mounts, including preparations of vaginal, cervical or skin specimens |
2,045 |
1,980 |
$8K |
| 99000 |
|
1,964 |
1,924 |
$7K |
| 83986 |
|
2,042 |
1,977 |
$6K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
238 |
226 |
$5K |
| 59425 |
|
50 |
46 |
$3K |
| 81002 |
|
857 |
826 |
$2K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
686 |
676 |
$1K |
| 99385 |
|
12 |
12 |
$1K |
| Q0144 |
Azithromycin dihydrate, oral, capsules/powder, 1 gram |
215 |
209 |
$1K |
| 58301 |
|
54 |
27 |
$1K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
13 |
13 |
$944.72 |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
145 |
141 |
$798.42 |
| S0191 |
Misoprostol, oral, 200 mcg |
168 |
163 |
$558.85 |
| G0442 |
Annual alcohol misuse screening, 5 to 15 minutes |
120 |
120 |
$456.90 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
41 |
41 |
$100.88 |
| 85018 |
|
30 |
29 |
$62.97 |
| S5000 |
Prescription drug, generic |
2,629 |
2,132 |
$11.36 |
| S0197 |
Prenatal vitamins, 30-day supply |
18 |
17 |
$4.77 |
| 1160F |
|
141 |
141 |
$0.00 |
| 1159F |
|
141 |
141 |
$0.00 |
| 3078F |
|
64 |
64 |
$0.00 |
| 3074F |
|
80 |
80 |
$0.00 |
| 2000F |
|
85 |
85 |
$0.00 |
| 1036F |
|
38 |
38 |
$0.00 |