| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J3490 |
Unclassified drugs |
820 |
690 |
$87K |
| Z1034 |
|
1,569 |
1,022 |
$86K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
760 |
620 |
$69K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
657 |
554 |
$40K |
| Z1032 |
|
201 |
201 |
$31K |
| Z6500 |
|
215 |
215 |
$27K |
| Z6400 |
|
1,320 |
952 |
$13K |
| Z6406 |
|
837 |
609 |
$13K |
| Z6410 |
|
843 |
489 |
$13K |
| Z6204 |
|
1,320 |
908 |
$10K |
| Z6304 |
|
870 |
520 |
$7K |
| 81025 |
|
1,876 |
1,875 |
$5K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
67 |
65 |
$5K |
| 99401 |
|
192 |
184 |
$3K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
30 |
15 |
$3K |
| A4267 |
Contraceptive supply, condom, male, each |
182 |
181 |
$2K |
| 99000 |
|
281 |
277 |
$1K |
| Z1038 |
|
12 |
12 |
$658.61 |
| S9445 |
Patient education, not otherwise classified, non-physician provider, individual, per session |
52 |
52 |
$636.00 |
| Z6414 |
|
28 |
26 |
$432.98 |
| Z6208 |
|
30 |
28 |
$231.66 |
| Z6308 |
|
30 |
28 |
$231.66 |
| 97803 |
|
149 |
105 |
$0.00 |
| H1003 |
Prenatal care, at-risk enhanced service; education |
25 |
16 |
$0.00 |