| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S4993 |
Contraceptive pills for birth control |
2,582 |
2,503 |
$258K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
8,044 |
7,351 |
$213K |
| A4267 |
Contraceptive supply, condom, male, each |
16,026 |
14,414 |
$184K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
2,551 |
2,513 |
$158K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
1,994 |
1,971 |
$137K |
| 99385 |
|
883 |
846 |
$54K |
| J7304 |
Contraceptive supply, hormone containing patch, each |
83 |
79 |
$39K |
| 81025 |
|
4,916 |
4,646 |
$33K |
| 80061 |
Lipid panel |
4,354 |
4,242 |
$31K |
| A9150 |
Non-prescription drugs |
1,808 |
1,719 |
$30K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
4,573 |
4,469 |
$27K |
| J7295 |
Ethinyl estradiol and etonogestrel 0.015mg, 0.12mg per 24 hours; monthly vaginal ring, each |
25 |
25 |
$24K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
2,093 |
2,022 |
$23K |
| G0433 |
Infectious agent antibody detection by enzyme-linked immunosorbent assay (elisa) technique, hiv-1 and/or hiv-2, screening |
1,448 |
1,401 |
$20K |
| J7307 |
Etonogestrel (contraceptive) implant system, including implant and supplies |
30 |
30 |
$19K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
885 |
880 |
$16K |
| G0475 |
Hiv antigen/antibody, combination assay, screening |
673 |
649 |
$14K |
| 82947 |
|
4,138 |
4,032 |
$8K |
| 81003 |
|
3,167 |
3,048 |
$6K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
193 |
188 |
$5K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
193 |
188 |
$5K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
74 |
73 |
$4K |
| 85018 |
|
2,399 |
2,308 |
$4K |
| 85014 |
|
1,918 |
1,855 |
$4K |
| 11982 |
|
25 |
25 |
$3K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
42 |
42 |
$1K |
| 87210 |
|
249 |
232 |
$1K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
33 |
31 |
$880.61 |
| 0011A |
|
25 |
25 |
$824.00 |
| 99000 |
|
86 |
79 |
$811.08 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
136 |
109 |
$535.11 |
| 90688 |
|
12 |
12 |
$201.72 |
| 88142 |
|
12 |
12 |
$170.20 |
| J3490 |
Unclassified drugs |
1,628 |
1,502 |
$0.00 |
| 91301 |
|
28 |
27 |
$0.00 |
| H1010 |
Non-medical family planning education, per session |
12 |
12 |
$0.00 |
| 90734 |
|
14 |
14 |
$0.00 |