| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S4993 |
Contraceptive pills for birth control |
110 |
110 |
$18K |
| J7307 |
Etonogestrel (contraceptive) implant system, including implant and supplies |
18 |
18 |
$15K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
152 |
152 |
$6K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
150 |
150 |
$5K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
58 |
58 |
$4K |
| J3490 |
Unclassified drugs |
149 |
148 |
$4K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
103 |
103 |
$4K |
| A4267 |
Contraceptive supply, condom, male, each |
82 |
82 |
$951.36 |
| 87806 |
|
31 |
31 |
$786.30 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
20 |
20 |
$501.82 |
| 81025 |
|
163 |
159 |
$450.80 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
12 |
12 |
$199.10 |
| 99000 |
|
30 |
30 |
$105.27 |
| Q0111 |
Wet mounts, including preparations of vaginal, cervical or skin specimens |
21 |
21 |
$76.86 |
| 83986 |
|
21 |
21 |
$66.78 |
| S5000 |
Prescription drug, generic |
65 |
62 |
$0.00 |