| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J7307 |
Etonogestrel implant system |
1,349 |
1,347 |
$1.16M |
| S0199 |
Med abortion inc all ex drug |
1,297 |
1,291 |
$961K |
| J7304 |
Contraceptive hormone patch |
993 |
991 |
$867K |
| 99213 |
|
7,621 |
7,314 |
$821K |
| 99214 |
|
4,702 |
4,592 |
$763K |
| J3490 |
Drugs unclassified injection |
17,499 |
14,479 |
$678K |
| S4993 |
Contraceptive pills for bc |
5,382 |
5,364 |
$652K |
| 99212 |
|
5,479 |
5,395 |
$410K |
| 99211 |
|
10,219 |
9,813 |
$383K |
| 99202 |
|
2,596 |
2,587 |
$350K |
| 99203 |
|
1,398 |
1,398 |
$312K |
| 11981 |
|
1,375 |
1,369 |
$255K |
| 87806 |
|
9,550 |
8,534 |
$245K |
| 11976 |
|
2,800 |
1,410 |
$198K |
| 99201 |
|
2,009 |
2,002 |
$159K |
| A4267 |
Male condom |
10,598 |
10,529 |
$144K |
| 99204 |
|
547 |
545 |
$139K |
| S0190 |
Mifepristone, oral, 200 mg |
1,191 |
1,188 |
$72K |
| 58300 |
|
598 |
304 |
$56K |
| 87661 |
|
1,727 |
1,721 |
$52K |
| 76815 |
|
525 |
512 |
$42K |
| 99401 |
|
1,868 |
1,849 |
$36K |
| S9445 |
Pt education noc individ |
2,386 |
2,386 |
$30K |
| J7303 |
Contraceptive vaginal ring |
105 |
105 |
$28K |
| 99000 |
|
7,432 |
7,245 |
$27K |
| 81025 |
|
8,518 |
8,432 |
$27K |
| 99402 |
|
557 |
557 |
$18K |
| 58301 |
|
424 |
218 |
$17K |
| T1999 |
Noc retail items andsupplies |
5,244 |
3,732 |
$16K |
| 83986 |
|
5,329 |
4,616 |
$16K |
| Q0111 |
Wet mounts/ w preparations |
4,142 |
4,044 |
$16K |
| S5000 |
Prescription drug, generic |
2,018 |
1,844 |
$15K |
| 99395 |
|
100 |
100 |
$13K |
| J7300 |
Intra copp contra (paragard) |
15 |
15 |
$10K |
| Q3014 |
Telehealth facility fee |
368 |
362 |
$9K |
| Q0144 |
Azithromycin dihydrate, oral |
1,006 |
954 |
$5K |
| S0191 |
Misoprostol, oral, 200 mcg |
1,384 |
1,364 |
$4K |
| G2012 |
Brief check in by md/qhp |
162 |
162 |
$3K |
| 11982 |
|
26 |
13 |
$2K |
| 81002 |
|
901 |
879 |
$2K |
| 85018 |
|
334 |
330 |
$771.57 |
| T1014 |
Telehealth transmit, per min |
368 |
362 |
$769.80 |
| J0696 |
Ceftriaxone sodium injection |
33 |
28 |
$165.42 |
| 86901 |
|
25 |
25 |
$50.75 |
| 87491 |
|
12 |
12 |
$0.00 |
| 87591 |
|
12 |
12 |
$0.00 |