| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
|
11,296 |
10,583 |
$737K |
| J7307 |
Etonogestrel implant system |
727 |
725 |
$626K |
| S0199 |
Med abortion inc all ex drug |
764 |
764 |
$509K |
| 99214 |
|
5,960 |
5,687 |
$458K |
| 99212 |
|
5,533 |
5,365 |
$339K |
| J3490 |
Drugs unclassified injection |
8,760 |
7,420 |
$332K |
| S4993 |
Contraceptive pills for bc |
2,369 |
2,352 |
$294K |
| 99202 |
|
1,966 |
1,963 |
$271K |
| 87806 |
|
8,292 |
7,301 |
$205K |
| 99211 |
|
5,786 |
5,641 |
$202K |
| 11981 |
|
783 |
780 |
$197K |
| J7304 |
Contraceptive hormone patch |
162 |
162 |
$168K |
| 99203 |
|
608 |
605 |
$131K |
| 99204 |
|
452 |
452 |
$111K |
| 11976 |
|
1,345 |
698 |
$91K |
| 58300 |
|
717 |
367 |
$80K |
| 99201 |
|
838 |
837 |
$68K |
| 90837 |
|
586 |
309 |
$56K |
| A4267 |
Male condom |
3,765 |
3,741 |
$51K |
| T1999 |
Noc retail items andsupplies |
3,833 |
2,849 |
$48K |
| S0190 |
Mifepristone, oral, 200 mg |
723 |
723 |
$43K |
| 76815 |
|
372 |
358 |
$32K |
| 87661 |
|
1,400 |
1,387 |
$30K |
| 99000 |
|
6,641 |
6,487 |
$23K |
| 81025 |
|
7,058 |
6,913 |
$21K |
| J7300 |
Intra copp contra (paragard) |
25 |
25 |
$21K |
| 99401 |
|
1,015 |
999 |
$19K |
| 58301 |
|
506 |
262 |
$17K |
| 99394 |
|
105 |
105 |
$14K |
| Q0111 |
Wet mounts/ w preparations |
3,666 |
3,582 |
$14K |
| 83986 |
|
4,283 |
3,833 |
$13K |
| 90686 |
|
598 |
598 |
$12K |
| 90651 |
|
53 |
53 |
$12K |
| J7298 |
Mirena, 52 mg |
12 |
12 |
$9K |
| 99402 |
|
267 |
267 |
$8K |
| S5000 |
Prescription drug, generic |
1,163 |
1,104 |
$8K |
| 90682 |
|
118 |
117 |
$6K |
| 11982 |
|
29 |
29 |
$5K |
| G2012 |
Brief check in by md/qhp |
302 |
271 |
$5K |
| Q3014 |
Telehealth facility fee |
204 |
118 |
$4K |
| 99395 |
|
39 |
39 |
$3K |
| S0191 |
Misoprostol, oral, 200 mcg |
875 |
869 |
$3K |
| T1014 |
Telehealth transmit, per min |
218 |
126 |
$3K |
| 90688 |
|
125 |
125 |
$2K |
| 87491 |
|
1,065 |
1,063 |
$2K |
| 87591 |
|
1,065 |
1,063 |
$2K |
| Q0144 |
Azithromycin dihydrate, oral |
356 |
332 |
$2K |
| S9445 |
Pt education noc individ |
155 |
155 |
$2K |
| 81002 |
|
1,064 |
1,031 |
$2K |
| 92551 |
|
70 |
70 |
$2K |
| 90630 |
|
65 |
65 |
$2K |
| 99393 |
|
13 |
13 |
$1K |
| 85018 |
|
498 |
489 |
$1K |
| 90685 |
|
46 |
45 |
$828.00 |
| 90832 |
|
16 |
12 |
$666.56 |
| 90715 |
|
16 |
16 |
$462.20 |
| 99396 |
|
25 |
24 |
$153.34 |
| J0696 |
Ceftriaxone sodium injection |
27 |
26 |
$130.93 |
| 3078F |
|
194 |
193 |
$0.00 |
| 3074F |
|
189 |
188 |
$0.00 |