| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| H1010 |
Nonmed family planning ed |
12,112 |
10,148 |
$809K |
| 87491 |
|
19,703 |
13,147 |
$755K |
| 87591 |
|
19,418 |
13,067 |
$749K |
| 87661 |
|
14,312 |
12,146 |
$422K |
| 87389 |
|
11,660 |
10,529 |
$249K |
| 86780 |
|
10,330 |
9,275 |
$95K |
| 99211 |
|
8,263 |
6,734 |
$80K |
| S4993 |
Contraceptive pills for bc |
1,701 |
1,540 |
$75K |
| 99201 |
|
2,274 |
2,176 |
$45K |
| 87798 |
|
1,352 |
1,237 |
$42K |
| 81025 |
|
5,027 |
4,448 |
$37K |
| A4267 |
Male condom |
9,397 |
8,139 |
$34K |
| A4268 |
Female condom |
3,785 |
3,093 |
$22K |
| 87081 |
|
2,421 |
2,192 |
$21K |
| 87205 |
|
2,085 |
1,799 |
$21K |
| 86592 |
|
2,691 |
2,474 |
$12K |
| 99212 |
|
542 |
452 |
$9K |
| 87563 |
|
357 |
333 |
$8K |
| 99202 |
|
283 |
259 |
$8K |
| 87529 |
|
131 |
82 |
$4K |
| 87210 |
|
2,403 |
2,140 |
$4K |
| 99214 |
|
110 |
102 |
$4K |
| 99203 |
|
108 |
94 |
$3K |
| 99204 |
|
70 |
62 |
$3K |
| 99213 |
|
115 |
104 |
$2K |
| S5001 |
Prescription drug,brand name |
972 |
767 |
$0.00 |
| S5000 |
Prescription drug, generic |
710 |
596 |
$0.00 |
| J8499 |
Oral prescrip drug non chemo |
335 |
321 |
$0.00 |
| 99215 |
Prolong outpt/office vis |
96 |
89 |
$0.00 |
| H0033 |
Oral med adm direct observe |
206 |
137 |
$0.00 |
| 86803 |
|
73 |
71 |
$0.00 |
| J0561 |
Penicillin g benzathine inj |
546 |
363 |
$0.00 |
| 87077 |
|
279 |
239 |
$0.00 |
| J0696 |
Ceftriaxone sodium injection |
878 |
722 |
$0.00 |
| 99205 |
Prolong outpt/office vis |
19 |
13 |
$0.00 |
| 83986 |
|
12 |
12 |
$0.00 |
| G8711 |
Pres antibx on/within 3 day |
19 |
15 |
$0.00 |