| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
214 |
213 |
$6K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
214 |
213 |
$6K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
40 |
40 |
$5K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
133 |
127 |
$4K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
182 |
181 |
$4K |
| 81025 |
|
65 |
65 |
$754.25 |
| 87480 |
|
16 |
14 |
$378.40 |
| 87660 |
|
16 |
14 |
$346.64 |
| 87510 |
|
16 |
14 |
$262.98 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
45 |
44 |
$223.52 |
| 86780 |
|
12 |
12 |
$200.40 |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
222 |
221 |
$0.00 |
| S4993 |
Contraceptive pills for birth control |
42 |
42 |
$0.00 |