| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0199 |
Med abortion inc all ex drug |
2,759 |
2,695 |
$1.35M |
| J7307 |
Etonogestrel implant system |
1,092 |
1,040 |
$999K |
| J7298 |
Mirena, 52 mg |
629 |
581 |
$550K |
| 99212 |
|
8,366 |
7,963 |
$489K |
| J3490 |
Drugs unclassified injection |
12,324 |
10,443 |
$390K |
| 59840 |
|
2,350 |
1,234 |
$382K |
| 90651 |
|
1,376 |
1,371 |
$358K |
| 58300 |
|
3,151 |
1,583 |
$305K |
| S4993 |
Contraceptive pills for bc |
2,152 |
2,139 |
$303K |
| 11981 |
|
1,003 |
992 |
$206K |
| 99202 |
|
2,031 |
1,983 |
$177K |
| S0190 |
Mifepristone, oral, 200 mg |
2,692 |
2,669 |
$157K |
| 99213 |
|
2,250 |
2,192 |
$156K |
| 76817 |
|
2,127 |
2,063 |
$137K |
| A4267 |
Male condom |
9,358 |
9,265 |
$130K |
| 11976 |
|
1,406 |
720 |
$77K |
| 99211 |
|
1,544 |
1,464 |
$50K |
| 99203 |
|
284 |
284 |
$45K |
| Q0144 |
Azithromycin dihydrate, oral |
3,463 |
3,301 |
$39K |
| 58301 |
|
1,391 |
705 |
$39K |
| G9920 |
Scrning perf and negative |
1,338 |
1,330 |
$37K |
| 99201 |
|
638 |
634 |
$33K |
| J7296 |
Kyleena, 19.5 mg |
29 |
29 |
$28K |
| 99152 |
|
548 |
546 |
$26K |
| 76815 |
|
463 |
456 |
$25K |
| J7300 |
Intra copp contra (paragard) |
26 |
26 |
$23K |
| 76830 |
|
276 |
272 |
$17K |
| S0191 |
Misoprostol, oral, 200 mcg |
2,690 |
2,666 |
$17K |
| S9445 |
Pt education noc individ |
756 |
756 |
$10K |
| 59841 |
|
23 |
12 |
$5K |
| Q0111 |
Wet mounts/ w preparations |
966 |
955 |
$5K |
| G2012 |
Brief check in by md/qhp |
376 |
349 |
$4K |
| 85018 |
|
377 |
375 |
$2K |
| 99000 |
|
518 |
514 |
$2K |
| G9919 |
Scrn nd pos nd prov of rec |
57 |
57 |
$2K |
| 83986 |
|
327 |
322 |
$904.73 |
| 86592 |
|
222 |
222 |
$841.06 |
| 01966 |
|
18 |
18 |
$678.45 |
| 87806 |
|
12 |
12 |
$259.56 |
| 87491 |
|
31 |
31 |
$249.36 |
| 87591 |
|
31 |
31 |
$248.56 |
| 81025 |
|
99 |
99 |
$56.12 |
| T1014 |
Telehealth transmit, per min |
27 |
26 |
$40.86 |