| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S4993 |
Contraceptive pills for birth control |
3,402 |
2,340 |
$277K |
| H1010 |
Non-medical family planning education, per session |
3,692 |
3,028 |
$263K |
| T1016 |
Case management, each 15 minutes |
1,238 |
1,216 |
$104K |
| H1000 |
Prenatal care, at-risk assessment |
1,060 |
1,046 |
$52K |
| A4267 |
Contraceptive supply, condom, male, each |
2,156 |
1,783 |
$33K |
| H1004 |
Prenatal care, at-risk enhanced service; follow-up home visit |
1,029 |
581 |
$25K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
272 |
245 |
$11K |
| 99000 |
|
2,790 |
2,386 |
$8K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
799 |
732 |
$8K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
203 |
192 |
$7K |
| 83655 |
|
523 |
507 |
$5K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
456 |
368 |
$4K |
| A4268 |
Contraceptive supply, condom, female, each |
169 |
160 |
$1K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
63 |
57 |
$1K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
18 |
16 |
$849.85 |
| Q0144 |
Azithromycin dihydrate, oral, capsules/powder, 1 gram |
87 |
82 |
$596.00 |
| J8499 |
Prescription drug, oral, non chemotherapeutic, nos |
13 |
12 |
$477.36 |
| 81025 |
|
41 |
41 |
$353.01 |
| 99201 |
|
14 |
12 |
$265.20 |
| J7303 |
Contraceptive supply, hormone containing vaginal ring, each |
13 |
12 |
$257.76 |
| 81002 |
|
77 |
73 |
$247.08 |
| 36416 |
|
155 |
155 |
$57.57 |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
1,435 |
1,172 |
$0.00 |
| 87661 |
Infectious agent detection by nucleic acid; Trichomonas vaginalis, amplified probe |
884 |
797 |
$0.00 |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
1,501 |
1,204 |
$0.00 |