| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,050 |
1,016 |
$149K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
401 |
401 |
$88K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
872 |
851 |
$56K |
| J3490 |
Unclassified drugs |
272 |
226 |
$16K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
13 |
13 |
$4K |
| 99201 |
|
118 |
115 |
$3K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
60 |
60 |
$2K |
| A4267 |
Contraceptive supply, condom, male, each |
415 |
405 |
$2K |
| S4993 |
Contraceptive pills for birth control |
40 |
39 |
$756.00 |
| S5199 |
Personal care item, nos, each |
432 |
422 |
$688.61 |
| 90715 |
|
127 |
127 |
$645.74 |
| 90707 |
|
112 |
111 |
$572.00 |
| 90716 |
|
114 |
113 |
$513.00 |
| 81025 |
|
114 |
111 |
$319.17 |
| 90651 |
|
17 |
17 |
$194.00 |
| 90713 |
|
52 |
52 |
$144.00 |
| 90734 |
|
16 |
16 |
$108.00 |
| 90744 |
|
28 |
28 |
$90.00 |