| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
|
6,709 |
6,295 |
$567K |
| J7307 |
Etonogestrel implant system |
402 |
402 |
$452K |
| J3490 |
Drugs unclassified injection |
8,899 |
7,411 |
$377K |
| 99212 |
|
5,551 |
5,369 |
$333K |
| S0199 |
Med abortion inc all ex drug |
778 |
774 |
$295K |
| S4993 |
Contraceptive pills for bc |
2,929 |
2,901 |
$293K |
| 99202 |
|
2,173 |
2,169 |
$259K |
| 99214 |
|
1,949 |
1,924 |
$253K |
| 99211 |
|
6,931 |
6,577 |
$235K |
| 87806 |
|
6,121 |
5,168 |
$125K |
| 11981 |
|
438 |
438 |
$122K |
| 99203 |
|
484 |
484 |
$98K |
| 99201 |
|
1,152 |
1,143 |
$92K |
| 58300 |
|
583 |
289 |
$70K |
| J7304 |
Contraceptive hormone patch |
69 |
69 |
$59K |
| A4267 |
Male condom |
3,971 |
3,948 |
$49K |
| 11976 |
|
486 |
252 |
$35K |
| S0190 |
Mifepristone, oral, 200 mg |
688 |
684 |
$32K |
| 87661 |
|
1,212 |
1,209 |
$29K |
| 81025 |
|
6,443 |
6,372 |
$16K |
| 76815 |
|
512 |
495 |
$16K |
| 58301 |
|
345 |
180 |
$13K |
| 99000 |
|
4,545 |
4,440 |
$12K |
| 83986 |
|
4,956 |
4,155 |
$12K |
| 99401 |
|
588 |
582 |
$11K |
| S9445 |
Pt education noc individ |
880 |
880 |
$11K |
| S5000 |
Prescription drug, generic |
1,387 |
1,282 |
$11K |
| Q0111 |
Wet mounts/ w preparations |
3,518 |
3,437 |
$11K |
| J7300 |
Intra copp contra (paragard) |
14 |
14 |
$10K |
| 99402 |
|
134 |
132 |
$4K |
| Q3014 |
Telehealth facility fee |
203 |
200 |
$4K |
| 99204 |
|
12 |
12 |
$3K |
| J8499 |
Oral prescrip drug non chemo |
225 |
146 |
$3K |
| S0191 |
Misoprostol, oral, 200 mcg |
737 |
729 |
$2K |
| 87491 |
|
1,799 |
1,768 |
$2K |
| T1999 |
Noc retail items andsupplies |
775 |
607 |
$1K |
| G2012 |
Brief check in by md/qhp |
131 |
123 |
$1K |
| Q0144 |
Azithromycin dihydrate, oral |
343 |
339 |
$1K |
| 81002 |
|
629 |
614 |
$906.12 |
| T1014 |
Telehealth transmit, per min |
203 |
200 |
$331.87 |
| 87591 |
|
1,754 |
1,723 |
$272.91 |
| 85018 |
|
89 |
88 |
$131.42 |
| J0696 |
Ceftriaxone sodium injection |
18 |
14 |
$69.41 |