| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| H1010 |
Non-medical family planning education, per session |
18,665 |
17,009 |
$1.61M |
| S4993 |
Contraceptive pills for birth control |
12,233 |
8,144 |
$893K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
6,197 |
5,790 |
$177K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,496 |
2,383 |
$114K |
| 87806 |
|
4,126 |
3,917 |
$102K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
2,860 |
2,726 |
$94K |
| A4267 |
Contraceptive supply, condom, male, each |
7,206 |
6,734 |
$87K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
1,573 |
1,515 |
$80K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
3,925 |
3,834 |
$70K |
| J8499 |
Prescription drug, oral, non chemotherapeutic, nos |
2,285 |
1,951 |
$60K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
590 |
568 |
$43K |
| 99000 |
|
9,819 |
9,244 |
$34K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
2,537 |
2,484 |
$31K |
| 81025 |
|
3,434 |
3,272 |
$28K |
| 90651 |
|
153 |
142 |
$24K |
| J7307 |
Etonogestrel (contraceptive) implant system, including implant and supplies |
26 |
26 |
$19K |
| Q0144 |
Azithromycin dihydrate, oral, capsules/powder, 1 gram |
736 |
682 |
$13K |
| 58300 |
|
357 |
340 |
$13K |
| 87210 |
|
1,911 |
1,835 |
$11K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
494 |
461 |
$10K |
| J7297 |
Levonorgestrel-releasing intrauterine contraceptive system (liletta), 52 mg |
80 |
79 |
$6K |
| J7304 |
Contraceptive supply, hormone containing patch, each |
26 |
25 |
$3K |
| 86703 |
|
225 |
221 |
$3K |
| 87563 |
|
80 |
71 |
$2K |
| Q3014 |
Telehealth originating site facility fee |
70 |
66 |
$1K |
| 81002 |
|
422 |
395 |
$1K |
| 11982 |
|
12 |
12 |
$1K |
| 11981 |
|
12 |
12 |
$910.25 |
| 58301 |
|
26 |
26 |
$778.50 |
| J7303 |
Contraceptive supply, hormone containing vaginal ring, each |
29 |
29 |
$523.90 |
| 99201 |
|
14 |
12 |
$250.20 |
| J3490 |
Unclassified drugs |
12 |
12 |
$151.74 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
102 |
101 |
$0.00 |
| 86803 |
|
15 |
12 |
$0.00 |