| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
6,196 |
5,868 |
$880K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
6,624 |
6,170 |
$641K |
| J3490 |
Unclassified drugs |
13,715 |
11,887 |
$479K |
| S4993 |
Contraceptive pills for birth control |
3,015 |
2,986 |
$342K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
6,979 |
6,405 |
$340K |
| 87806 |
|
13,080 |
11,340 |
$339K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
3,520 |
3,406 |
$239K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
617 |
614 |
$158K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
682 |
651 |
$157K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
1,107 |
1,041 |
$152K |
| 59840 |
|
753 |
378 |
$137K |
| J7307 |
Etonogestrel (contraceptive) implant system, including implant and supplies |
143 |
140 |
$120K |
| J7304 |
Contraceptive supply, hormone containing patch, each |
149 |
145 |
$94K |
| S0199 |
Medically induced abortion by oral ingestion of medication including all associated services and supplies (e.g., patient counseling, office visits, confirmation of pregnancy by hcg, ultrasound to confirm duration of pregnancy, ultrasound to confirm completion of abortion) except drugs |
151 |
151 |
$71K |
| 99201 |
|
582 |
561 |
$58K |
| A4267 |
Contraceptive supply, condom, male, each |
6,674 |
6,615 |
$47K |
| 81025 |
|
14,537 |
14,258 |
$44K |
| 99000 |
|
8,600 |
8,404 |
$34K |
| 11981 |
|
143 |
140 |
$31K |
| S5000 |
Prescription drug, generic |
4,847 |
4,305 |
$29K |
| 83986 |
|
6,790 |
6,077 |
$21K |
| 58300 |
|
168 |
84 |
$15K |
| S9445 |
Patient education, not otherwise classified, non-physician provider, individual, per session |
1,072 |
1,072 |
$14K |
| Q0111 |
Wet mounts, including preparations of vaginal, cervical or skin specimens |
3,486 |
3,432 |
$13K |
| 11976 |
|
219 |
110 |
$12K |
| J7298 |
Levonorgestrel-releasing intrauterine contraceptive system (mirena), 52 mg |
16 |
16 |
$11K |
| 99152 |
|
210 |
208 |
$10K |
| 82120 |
|
2,241 |
2,175 |
$9K |
| J7300 |
Intrauterine copper contraceptive (paragard) |
12 |
12 |
$8K |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
115 |
114 |
$8K |
| Q0144 |
Azithromycin dihydrate, oral, capsules/powder, 1 gram |
1,078 |
904 |
$6K |
| 64435 |
|
152 |
152 |
$6K |
| S5199 |
Personal care item, nos, each |
5,968 |
5,912 |
$6K |
| S0190 |
Mifepristone, oral, 200 mg |
90 |
90 |
$6K |
| J7303 |
Contraceptive supply, hormone containing vaginal ring, each |
43 |
43 |
$5K |
| 87210 |
|
1,290 |
1,255 |
$5K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
33 |
31 |
$3K |
| 81002 |
|
1,106 |
1,083 |
$2K |
| 58301 |
|
54 |
27 |
$2K |
| 99401 |
|
67 |
67 |
$1K |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
223 |
206 |
$1K |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
214 |
196 |
$1K |
| 85018 |
|
333 |
327 |
$686.62 |
| S0191 |
Misoprostol, oral, 200 mcg |
139 |
137 |
$403.69 |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
34 |
30 |
$166.89 |
| 90791 |
Psychiatric diagnostic evaluation |
26 |
26 |
$0.00 |