| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J3490 |
Unclassified drugs |
2,739 |
2,297 |
$138K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,157 |
1,999 |
$120K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
2,831 |
2,600 |
$98K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
2,829 |
2,598 |
$97K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,412 |
1,287 |
$64K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
635 |
603 |
$58K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
677 |
620 |
$52K |
| 87661 |
Infectious agent detection by nucleic acid; Trichomonas vaginalis, amplified probe |
1,114 |
1,110 |
$32K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
233 |
222 |
$23K |
| S4993 |
Contraceptive pills for birth control |
551 |
475 |
$22K |
| 86701 |
|
2,905 |
2,642 |
$20K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
395 |
374 |
$13K |
| A4267 |
Contraceptive supply, condom, male, each |
1,677 |
1,565 |
$12K |
| 86592 |
|
2,444 |
2,264 |
$8K |
| 81025 |
|
2,323 |
2,154 |
$7K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
62 |
62 |
$5K |
| 86580 |
|
1,504 |
1,491 |
$5K |
| 99201 |
|
56 |
56 |
$4K |
| 90715 |
|
260 |
260 |
$2K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
123 |
72 |
$1K |
| 90710 |
|
138 |
138 |
$999.00 |
| 90716 |
|
126 |
125 |
$963.06 |
| Q0144 |
Azithromycin dihydrate, oral, capsules/powder, 1 gram |
203 |
149 |
$885.83 |
| 90696 |
|
106 |
105 |
$783.00 |
| 99401 |
|
37 |
36 |
$705.59 |
| 90713 |
|
84 |
84 |
$684.00 |
| 90707 |
|
66 |
65 |
$544.06 |
| 86803 |
|
47 |
43 |
$490.24 |
| 90656 |
|
46 |
46 |
$324.12 |
| 90700 |
|
30 |
30 |
$252.00 |
| 90686 |
|
26 |
26 |
$225.00 |
| 90734 |
|
29 |
29 |
$189.00 |
| 90649 |
|
25 |
25 |
$171.00 |
| 90723 |
|
13 |
13 |
$117.00 |
| 90633 |
|
13 |
13 |
$117.00 |
| 90744 |
|
14 |
14 |
$72.00 |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
16 |
12 |
$61.24 |