| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J3490 |
Drugs unclassified injection |
18,969 |
14,569 |
$326K |
| 99213 |
|
4,976 |
4,766 |
$309K |
| 99214 |
|
2,920 |
2,778 |
$278K |
| 99211 |
|
10,725 |
9,783 |
$258K |
| 99202 |
|
2,189 |
2,174 |
$220K |
| S4993 |
Contraceptive pills for bc |
2,977 |
2,904 |
$219K |
| 99212 |
|
4,543 |
4,377 |
$216K |
| S0199 |
Med abortion inc all ex drug |
1,134 |
1,127 |
$162K |
| J7307 |
Etonogestrel implant system |
223 |
221 |
$147K |
| 87806 |
|
7,320 |
6,424 |
$105K |
| 99201 |
|
1,291 |
1,265 |
$93K |
| A4267 |
Male condom |
8,950 |
8,398 |
$83K |
| 99203 |
|
342 |
342 |
$73K |
| 11981 |
|
174 |
173 |
$31K |
| 87661 |
|
1,326 |
1,320 |
$26K |
| S0190 |
Mifepristone, oral, 200 mg |
1,049 |
1,037 |
$16K |
| 11976 |
|
304 |
153 |
$15K |
| S9445 |
Pt education noc individ |
1,161 |
1,161 |
$15K |
| S5000 |
Prescription drug, generic |
1,967 |
1,824 |
$14K |
| 81025 |
|
9,027 |
8,642 |
$12K |
| 76815 |
|
1,076 |
1,044 |
$12K |
| 99000 |
|
4,731 |
4,624 |
$11K |
| 99204 |
|
51 |
51 |
$11K |
| 99401 |
|
422 |
417 |
$8K |
| 83986 |
|
4,634 |
4,117 |
$8K |
| Q0111 |
Wet mounts/ w preparations |
3,656 |
3,465 |
$7K |
| 99402 |
|
99 |
98 |
$3K |
| Q0144 |
Azithromycin dihydrate, oral |
826 |
737 |
$2K |
| Q3014 |
Telehealth facility fee |
75 |
74 |
$1K |
| G2012 |
Brief check in by md/qhp |
162 |
160 |
$1K |
| S0191 |
Misoprostol, oral, 200 mcg |
1,200 |
1,166 |
$1K |
| T1999 |
Noc retail items andsupplies |
353 |
235 |
$975.00 |
| 0270 |
|
2,463 |
1,602 |
$769.81 |
| 81002 |
|
316 |
303 |
$417.14 |
| 85018 |
|
470 |
454 |
$312.65 |
| 87591 |
|
1,146 |
1,141 |
$141.95 |
| 87491 |
|
1,107 |
1,102 |
$110.12 |
| 86901 |
|
86 |
85 |
$73.80 |
| J0696 |
Ceftriaxone sodium injection |
16 |
15 |
$70.72 |
| T1014 |
Telehealth transmit, per min |
59 |
58 |
$63.84 |
| 99070 |
|
42 |
26 |
$0.00 |