| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S9430 |
Pharmacy comp/disp serv |
63,214 |
60,965 |
$6.34M |
| 99213 |
|
48,789 |
47,028 |
$2.98M |
| S4993 |
Contraceptive pills for bc |
76,284 |
64,651 |
$2.62M |
| 99212 |
|
25,219 |
24,553 |
$997K |
| 99202 |
|
15,877 |
15,455 |
$850K |
| J1050 |
Medroxyprogesterone acetate |
26,067 |
25,581 |
$731K |
| 81025 |
|
71,717 |
69,645 |
$693K |
| 99214 |
|
4,910 |
4,793 |
$682K |
| 99395 |
|
4,381 |
4,280 |
$453K |
| 96372 |
|
30,784 |
29,775 |
$414K |
| 58300 |
|
1,092 |
1,075 |
$356K |
| 99203 |
|
3,346 |
3,290 |
$344K |
| J7304 |
Contraceptive hormone patch |
354 |
323 |
$173K |
| J7307 |
Etonogestrel implant system |
442 |
436 |
$172K |
| 86703 |
|
12,635 |
12,462 |
$165K |
| 36415 |
|
22,742 |
21,885 |
$118K |
| J3490 |
Drugs unclassified injection |
8,010 |
7,596 |
$82K |
| A4267 |
Male condom |
8,774 |
8,364 |
$69K |
| 87210 |
|
14,025 |
13,750 |
$67K |
| 11981 |
|
207 |
204 |
$65K |
| S0199 |
Med abortion inc all ex drug |
246 |
241 |
$62K |
| 99201 |
|
1,948 |
1,888 |
$58K |
| 76817 |
|
653 |
576 |
$37K |
| 36416 |
|
15,004 |
14,776 |
$31K |
| J7297 |
Liletta, 52 mg |
386 |
382 |
$29K |
| 99385 |
|
288 |
285 |
$26K |
| 59899 |
|
130 |
128 |
$23K |
| 59840 |
|
260 |
219 |
$20K |
| 99421 |
|
1,312 |
1,306 |
$19K |
| 58301 |
|
325 |
317 |
$19K |
| 11982 |
|
177 |
177 |
$13K |
| 99204 |
|
61 |
61 |
$13K |
| 90651 |
|
73 |
70 |
$13K |
| S0190 |
Mifepristone, oral, 200 mg |
293 |
265 |
$5K |
| 81002 |
|
1,502 |
1,473 |
$4K |
| 82120 |
|
790 |
771 |
$4K |
| J7303 |
Contraceptive vaginal ring |
105 |
98 |
$4K |
| 76815 |
|
104 |
94 |
$3K |
| J7298 |
Mirena, 52 mg |
14 |
14 |
$3K |
| J7300 |
Intra copp contra (paragard) |
12 |
12 |
$3K |
| 83986 |
|
837 |
804 |
$3K |
| 85018 |
|
893 |
819 |
$2K |
| A4269 |
Spermicide |
193 |
160 |
$839.17 |
| 90471 |
|
79 |
76 |
$603.37 |
| 86901 |
|
265 |
220 |
$568.91 |
| S0191 |
Misoprostol, oral, 200 mcg |
488 |
394 |
$357.20 |
| J0696 |
Ceftriaxone sodium injection |
12 |
12 |
$6.45 |