| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J7307 |
Etonogestrel implant system |
1,491 |
1,486 |
$1.18M |
| 99213 |
|
15,336 |
14,658 |
$923K |
| S4993 |
Contraceptive pills for bc |
6,663 |
6,619 |
$659K |
| 99214 |
|
6,791 |
6,577 |
$645K |
| J3490 |
Drugs unclassified injection |
22,818 |
18,776 |
$592K |
| 99202 |
|
5,593 |
5,565 |
$521K |
| J7304 |
Contraceptive hormone patch |
602 |
597 |
$440K |
| 99211 |
|
18,695 |
17,977 |
$413K |
| 99212 |
|
6,954 |
6,795 |
$401K |
| 99203 |
|
1,812 |
1,807 |
$364K |
| 11981 |
|
1,545 |
1,540 |
$272K |
| 87806 |
|
15,558 |
13,683 |
$262K |
| J7300 |
Intra copp contra (paragard) |
356 |
353 |
$234K |
| 99204 |
|
984 |
983 |
$233K |
| J7298 |
Mirena, 52 mg |
348 |
345 |
$228K |
| 58300 |
|
2,830 |
1,441 |
$228K |
| S0199 |
Med abortion inc all ex drug |
871 |
869 |
$217K |
| 99201 |
|
2,280 |
2,246 |
$162K |
| 90651 |
|
580 |
578 |
$145K |
| 57454 |
|
1,976 |
1,002 |
$103K |
| 87661 |
|
5,025 |
4,984 |
$85K |
| 11976 |
|
1,527 |
790 |
$83K |
| A4267 |
Male condom |
11,525 |
11,368 |
$73K |
| 99402 |
|
2,015 |
1,985 |
$64K |
| 87491 |
|
12,090 |
11,898 |
$55K |
| 76815 |
|
2,279 |
2,213 |
$54K |
| 58301 |
|
2,057 |
1,061 |
$51K |
| 99401 |
|
2,162 |
2,132 |
$41K |
| 99403 |
|
774 |
766 |
$34K |
| 81025 |
|
15,087 |
14,809 |
$34K |
| S5000 |
Prescription drug, generic |
3,980 |
3,778 |
$29K |
| J7303 |
Contraceptive vaginal ring |
152 |
151 |
$29K |
| 59840 |
|
280 |
145 |
$28K |
| 99000 |
|
12,968 |
12,682 |
$27K |
| S9445 |
Pt education noc individ |
2,109 |
2,109 |
$27K |
| S0190 |
Mifepristone, oral, 200 mg |
776 |
775 |
$21K |
| 83986 |
|
8,734 |
7,700 |
$18K |
| 87591 |
|
12,058 |
11,865 |
$18K |
| Q0111 |
Wet mounts/ w preparations |
6,669 |
6,520 |
$17K |
| 11982 |
|
412 |
207 |
$9K |
| J8499 |
Oral prescrip drug non chemo |
861 |
547 |
$9K |
| 57460 |
|
50 |
25 |
$6K |
| Q3014 |
Telehealth facility fee |
473 |
469 |
$6K |
| 81002 |
|
2,307 |
2,229 |
$3K |
| Q0144 |
Azithromycin dihydrate, oral |
1,038 |
972 |
$3K |
| G2012 |
Brief check in by md/qhp |
224 |
216 |
$2K |
| 85018 |
|
1,380 |
1,350 |
$1K |
| S0191 |
Misoprostol, oral, 200 mcg |
948 |
938 |
$1K |
| J0696 |
Ceftriaxone sodium injection |
317 |
312 |
$1K |
| 90471 |
|
391 |
389 |
$1K |
| 99152 |
|
32 |
28 |
$1K |
| 76830 |
|
13 |
13 |
$723.28 |
| T1014 |
Telehealth transmit, per min |
475 |
471 |
$624.19 |
| 76817 |
|
12 |
12 |
$507.88 |
| 86901 |
|
168 |
167 |
$219.45 |
| Z7610 |
|
28 |
24 |
$189.58 |
| 99070 |
|
23 |
13 |
$51.40 |
| 90686 |
|
56 |
56 |
$46.98 |
| J3010 |
Fentanyl citrate injection |
14 |
14 |
$39.00 |
| J2250 |
Inj midazolam hydrochloride |
13 |
13 |
$19.00 |
| 3079F |
|
34 |
31 |
$0.00 |
| 3074F |
|
138 |
136 |
$0.00 |
| 1220F |
|
13 |
13 |
$0.00 |
| 3078F |
|
80 |
78 |
$0.00 |
| 3077F |
|
15 |
13 |
$0.00 |