| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| H1010 |
Non-medical family planning education, per session |
4,227 |
3,721 |
$343K |
| S4993 |
Contraceptive pills for birth control |
3,566 |
2,491 |
$245K |
| A4267 |
Contraceptive supply, condom, male, each |
1,681 |
1,521 |
$26K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
310 |
252 |
$11K |
| 87661 |
Infectious agent detection by nucleic acid; Trichomonas vaginalis, amplified probe |
480 |
445 |
$8K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
1,438 |
1,134 |
$7K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
1,399 |
1,096 |
$7K |
| 99000 |
|
1,378 |
1,181 |
$4K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
162 |
154 |
$4K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
106 |
98 |
$2K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
45 |
41 |
$2K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
107 |
100 |
$1K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
12 |
12 |
$724.56 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
14 |
13 |
$414.12 |
| 81025 |
|
69 |
45 |
$284.13 |
| J8499 |
Prescription drug, oral, non chemotherapeutic, nos |
12 |
12 |
$19.75 |
| A4268 |
Contraceptive supply, condom, female, each |
394 |
327 |
$0.00 |
| 88142 |
|
12 |
12 |
$0.00 |