| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S4993 |
Contraceptive pills for birth control |
1,833 |
1,787 |
$262K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
2,578 |
2,543 |
$168K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
6,082 |
4,533 |
$152K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
6,083 |
4,532 |
$152K |
| 99385 |
|
1,798 |
1,759 |
$128K |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
5,869 |
5,764 |
$90K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
1,253 |
1,246 |
$89K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,853 |
2,692 |
$80K |
| J7307 |
Etonogestrel (contraceptive) implant system, including implant and supplies |
54 |
52 |
$41K |
| 81025 |
|
5,574 |
5,390 |
$38K |
| A9150 |
Non-prescription drugs |
2,575 |
2,006 |
$30K |
| A4269 |
Contraceptive supply, spermicide (e.g., foam, gel), each |
173 |
169 |
$26K |
| J7304 |
Contraceptive supply, hormone containing patch, each |
27 |
27 |
$22K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
1,573 |
1,528 |
$18K |
| 87210 |
|
2,680 |
2,574 |
$12K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
470 |
456 |
$9K |
| A4267 |
Contraceptive supply, condom, male, each |
1,228 |
1,180 |
$8K |
| 81002 |
|
1,643 |
1,598 |
$5K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
505 |
494 |
$4K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
327 |
308 |
$3K |
| 80061 |
Lipid panel |
496 |
488 |
$2K |
| 82947 |
|
497 |
489 |
$2K |
| 85018 |
|
708 |
687 |
$1K |
| 76830 |
Ultrasound, transvaginal |
13 |
13 |
$1K |
| 85014 |
|
381 |
372 |
$666.70 |
| G0433 |
Infectious agent antibody detection by enzyme-linked immunosorbent assay (elisa) technique, hiv-1 and/or hiv-2, screening |
30 |
30 |
$399.36 |
| 88142 |
|
39 |
38 |
$221.26 |
| 97802 |
|
28 |
28 |
$30.31 |
| J8499 |
Prescription drug, oral, non chemotherapeutic, nos |
231 |
231 |
$0.00 |
| S5000 |
Prescription drug, generic |
1,067 |
916 |
$0.00 |