| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
|
2,696 |
2,622 |
$257K |
| J3490 |
Drugs unclassified injection |
3,015 |
2,942 |
$115K |
| 87806 |
|
4,021 |
4,011 |
$114K |
| 99202 |
|
878 |
876 |
$111K |
| 99212 |
|
1,234 |
1,199 |
$84K |
| S0199 |
Med abortion inc all ex drug |
123 |
123 |
$77K |
| S4993 |
Contraceptive pills for bc |
668 |
661 |
$75K |
| 99211 |
|
942 |
939 |
$44K |
| 99203 |
|
167 |
167 |
$38K |
| 99214 |
|
284 |
283 |
$37K |
| J7307 |
Etonogestrel implant system |
28 |
28 |
$32K |
| 86780 |
|
2,580 |
2,577 |
$29K |
| A4267 |
Male condom |
1,277 |
1,271 |
$15K |
| S5000 |
Prescription drug, generic |
941 |
871 |
$11K |
| A4649 |
Surgical supplies |
697 |
568 |
$10K |
| S9445 |
Pt education noc individ |
759 |
759 |
$10K |
| 87491 |
|
334 |
334 |
$9K |
| 87591 |
|
334 |
334 |
$9K |
| 81025 |
|
2,506 |
2,478 |
$8K |
| 87808 |
|
625 |
616 |
$7K |
| 11981 |
|
27 |
26 |
$6K |
| S0190 |
Mifepristone, oral, 200 mg |
80 |
80 |
$5K |
| 83986 |
|
898 |
880 |
$3K |
| 11976 |
|
28 |
14 |
$3K |
| 87210 |
|
422 |
407 |
$2K |
| 87801 |
|
37 |
36 |
$2K |
| Q0111 |
Wet mounts/ w preparations |
231 |
228 |
$847.46 |
| 58301 |
|
24 |
12 |
$773.04 |
| 81002 |
|
131 |
125 |
$300.15 |
| 86803 |
|
13 |
13 |
$183.49 |
| S0191 |
Misoprostol, oral, 200 mcg |
82 |
81 |
$76.90 |