| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| H1010 |
Non-medical family planning education, per session |
4,797 |
4,450 |
$422K |
| S4993 |
Contraceptive pills for birth control |
2,326 |
1,532 |
$172K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,308 |
1,240 |
$36K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
748 |
711 |
$25K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
1,043 |
1,004 |
$16K |
| 87806 |
|
583 |
556 |
$14K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
270 |
266 |
$12K |
| A4267 |
Contraceptive supply, condom, male, each |
944 |
905 |
$12K |
| 99000 |
|
2,172 |
2,064 |
$8K |
| J8499 |
Prescription drug, oral, non chemotherapeutic, nos |
289 |
236 |
$8K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
425 |
416 |
$5K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
59 |
58 |
$5K |
| 90651 |
|
26 |
26 |
$4K |
| 81025 |
|
232 |
218 |
$2K |
| 87210 |
|
326 |
310 |
$2K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
13 |
13 |
$678.44 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
13 |
13 |
$291.19 |
| Q3014 |
Telehealth originating site facility fee |
12 |
12 |
$272.28 |
| 81002 |
|
15 |
14 |
$48.72 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
26 |
26 |
$0.00 |