| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
672 |
652 |
$63K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
1,343 |
982 |
$27K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
1,324 |
1,276 |
$26K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
455 |
448 |
$26K |
| J7307 |
Etonogestrel (contraceptive) implant system, including implant and supplies |
13 |
13 |
$10K |
| 81025 |
|
696 |
669 |
$8K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
309 |
302 |
$7K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
309 |
302 |
$7K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
60 |
57 |
$5K |
| A4267 |
Contraceptive supply, condom, male, each |
319 |
306 |
$1K |
| 88175 |
Cytopathology, cervical or vaginal, any reporting system; collected in preservative fluid, automated thin layer |
27 |
27 |
$814.18 |
| 87210 |
|
47 |
46 |
$340.62 |
| S4993 |
Contraceptive pills for birth control |
195 |
51 |
$0.00 |
| T5999 |
Supply, not otherwise specified |
49 |
46 |
$0.00 |