| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J7304 |
Contraceptive supply, hormone containing patch, each |
30 |
30 |
$37K |
| 99214 |
|
377 |
373 |
$27K |
| J7307 |
Etonogestrel (contraceptive) implant system, including implant and supplies |
15 |
15 |
$15K |
| S4993 |
Contraceptive pills for birth control |
45 |
45 |
$8K |
| J3490 |
Unclassified drugs |
253 |
251 |
$7K |
| S0199 |
Medically induced abortion by oral ingestion of medication including all associated services and supplies (e.g., patient counseling, office visits, confirmation of pregnancy by hcg, ultrasound to confirm duration of pregnancy, ultrasound to confirm completion of abortion) except drugs |
12 |
12 |
$7K |
| 99213 |
|
116 |
113 |
$4K |
| 99212 |
|
80 |
80 |
$3K |
| 87806 |
|
98 |
98 |
$3K |
| A4267 |
Contraceptive supply, condom, male, each |
239 |
237 |
$2K |
| 81025 |
|
653 |
644 |
$2K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
19 |
18 |
$2K |
| S0190 |
Mifepristone, oral, 200 mg |
12 |
12 |
$714.84 |
| Q0111 |
Wet mounts, including preparations of vaginal, cervical or skin specimens |
168 |
166 |
$645.54 |
| 83986 |
|
153 |
151 |
$496.68 |
| 99000 |
|
105 |
105 |
$381.15 |
| 90471 |
|
40 |
40 |
$227.42 |
| S5000 |
Prescription drug, generic |
26 |
26 |
$139.26 |
| 81002 |
|
36 |
36 |
$68.76 |
| S0191 |
Misoprostol, oral, 200 mcg |
12 |
12 |
$35.04 |