| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
391 |
384 |
$56K |
| 99201 |
|
156 |
156 |
$21K |
| J3490 |
Unclassified drugs |
251 |
196 |
$20K |
| A4267 |
Contraceptive supply, condom, male, each |
1,378 |
1,369 |
$16K |
| 99402 |
|
417 |
410 |
$13K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
59 |
59 |
$13K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
37 |
37 |
$12K |
| S5199 |
Personal care item, nos, each |
1,366 |
1,357 |
$4K |
| 99401 |
|
164 |
162 |
$3K |
| 81025 |
|
677 |
652 |
$2K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
14 |
14 |
$1K |
| 86701 |
|
31 |
31 |
$245.21 |
| 81002 |
|
51 |
51 |
$88.58 |