| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S4993 |
Contraceptive pills for birth control |
1,466 |
1,438 |
$157K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
1,672 |
1,655 |
$115K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
4,286 |
4,032 |
$114K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
1,486 |
1,478 |
$92K |
| A4267 |
Contraceptive supply, condom, male, each |
8,997 |
8,323 |
$61K |
| J7295 |
Ethinyl estradiol and etonogestrel 0.015mg, 0.12mg per 24 hours; monthly vaginal ring, each |
85 |
79 |
$59K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
1,731 |
1,682 |
$19K |
| 80061 |
Lipid panel |
2,430 |
2,394 |
$18K |
| J7307 |
Etonogestrel (contraceptive) implant system, including implant and supplies |
24 |
24 |
$17K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
952 |
937 |
$17K |
| 81025 |
|
2,220 |
2,165 |
$15K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
2,077 |
2,047 |
$12K |
| G0433 |
Infectious agent antibody detection by enzyme-linked immunosorbent assay (elisa) technique, hiv-1 and/or hiv-2, screening |
609 |
600 |
$9K |
| G0475 |
Hiv antigen/antibody, combination assay, screening |
318 |
305 |
$7K |
| A9150 |
Non-prescription drugs |
449 |
428 |
$6K |
| 82947 |
|
2,372 |
2,335 |
$5K |
| J7303 |
Contraceptive supply, hormone containing vaginal ring, each |
12 |
12 |
$4K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
112 |
104 |
$3K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
112 |
104 |
$3K |
| 81003 |
|
1,221 |
1,191 |
$2K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
60 |
58 |
$2K |
| 85018 |
|
1,061 |
1,035 |
$2K |
| 85014 |
|
871 |
850 |
$2K |
| 99385 |
|
26 |
25 |
$2K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
29 |
29 |
$1K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
186 |
179 |
$1K |
| 90688 |
|
50 |
50 |
$738.38 |
| 99000 |
|
17 |
17 |
$181.44 |
| J3490 |
Unclassified drugs |
254 |
235 |
$0.00 |