| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J7307 |
Etonogestrel implant system |
172 |
167 |
$139K |
| S4993 |
Contraceptive pills for bc |
443 |
440 |
$65K |
| 99213 |
|
1,104 |
890 |
$46K |
| 87491 |
|
1,155 |
1,153 |
$43K |
| 87591 |
|
1,151 |
1,149 |
$43K |
| J1050 |
Medroxyprogesterone acetate |
264 |
264 |
$18K |
| Q0144 |
Azithromycin dihydrate, oral |
450 |
448 |
$15K |
| A4267 |
Male condom |
1,116 |
1,103 |
$13K |
| J3490 |
Drugs unclassified injection |
534 |
525 |
$12K |
| 99214 |
|
159 |
129 |
$10K |
| 87806 |
|
363 |
361 |
$9K |
| 99212 |
|
198 |
158 |
$5K |
| 81025 |
|
1,294 |
1,276 |
$4K |
| 57454 |
|
55 |
27 |
$4K |
| 11981 |
|
15 |
15 |
$3K |
| 90651 |
|
13 |
12 |
$3K |
| 58300 |
|
26 |
12 |
$2K |
| 76817 |
|
27 |
27 |
$2K |
| Q0111 |
Wet mounts/ w preparations |
397 |
390 |
$2K |
| 99203 |
|
16 |
13 |
$2K |
| S0190 |
Mifepristone, oral, 200 mg |
32 |
28 |
$2K |
| 83986 |
|
395 |
388 |
$1K |
| 99211 |
|
26 |
26 |
$546.88 |
| 99000 |
|
180 |
176 |
$295.65 |
| J1885 |
Ketorolac tromethamine inj |
51 |
51 |
$222.91 |
| 81002 |
|
80 |
78 |
$196.67 |
| 85018 |
|
40 |
40 |
$78.84 |
| S0191 |
Misoprostol, oral, 200 mcg |
18 |
14 |
$25.36 |
| S5000 |
Prescription drug, generic |
101 |
95 |
$0.00 |
| S5001 |
Prescription drug,brand name |
15 |
15 |
$0.00 |