| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,414 |
2,132 |
$265K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,527 |
1,343 |
$258K |
| J3490 |
Unclassified drugs |
5,464 |
4,507 |
$195K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
3,443 |
2,929 |
$191K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
2,064 |
1,955 |
$171K |
| 87806 |
|
6,183 |
4,710 |
$157K |
| S4993 |
Contraceptive pills for birth control |
1,248 |
1,239 |
$140K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
394 |
363 |
$63K |
| 99201 |
|
439 |
438 |
$51K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
148 |
146 |
$38K |
| A4267 |
Contraceptive supply, condom, male, each |
3,518 |
3,510 |
$26K |
| S9445 |
Patient education, not otherwise classified, non-physician provider, individual, per session |
1,212 |
1,212 |
$15K |
| 81025 |
|
5,099 |
5,012 |
$15K |
| 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 |
25 |
25 |
$12K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
39 |
39 |
$11K |
| S5000 |
Prescription drug, generic |
1,536 |
1,369 |
$9K |
| 99000 |
|
2,425 |
2,383 |
$9K |
| 83986 |
|
2,397 |
1,969 |
$7K |
| Q0111 |
Wet mounts, including preparations of vaginal, cervical or skin specimens |
1,065 |
1,050 |
$4K |
| S5199 |
Personal care item, nos, each |
3,686 |
3,666 |
$4K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
29 |
29 |
$2K |
| J7303 |
Contraceptive supply, hormone containing vaginal ring, each |
26 |
25 |
$2K |
| S0190 |
Mifepristone, oral, 200 mg |
25 |
25 |
$2K |
| Q0144 |
Azithromycin dihydrate, oral, capsules/powder, 1 gram |
191 |
168 |
$1K |
| 82120 |
|
110 |
108 |
$435.80 |
| 87210 |
|
77 |
75 |
$286.36 |
| 81002 |
|
114 |
113 |
$226.54 |
| S0191 |
Misoprostol, oral, 200 mcg |
37 |
37 |
$113.75 |