| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| H1010 |
Nonmed family planning ed |
49,475 |
44,722 |
$4.19M |
| S4993 |
Contraceptive pills for bc |
37,566 |
23,582 |
$2.59M |
| 99214 |
|
13,336 |
12,707 |
$739K |
| 99213 |
|
16,679 |
15,575 |
$594K |
| J8499 |
Oral prescrip drug non chemo |
13,804 |
11,370 |
$329K |
| A4267 |
Male condom |
26,300 |
24,767 |
$324K |
| 87806 |
|
8,959 |
8,612 |
$222K |
| 99202 |
|
4,141 |
4,008 |
$165K |
| J1050 |
Medroxyprogesterone acetate |
8,429 |
8,202 |
$153K |
| 99203 |
|
2,416 |
2,328 |
$151K |
| J7307 |
Etonogestrel implant system |
313 |
306 |
$142K |
| 99204 |
|
1,328 |
1,290 |
$126K |
| 99000 |
|
25,858 |
24,690 |
$91K |
| 87210 |
|
12,565 |
11,939 |
$70K |
| 81025 |
|
8,258 |
7,911 |
$68K |
| 99211 |
|
4,380 |
4,257 |
$62K |
| Q0144 |
Azithromycin dihydrate, oral |
3,382 |
3,183 |
$61K |
| 99212 |
|
1,921 |
1,848 |
$54K |
| J7304 |
Contraceptive hormone patch |
243 |
236 |
$44K |
| 90651 |
|
209 |
199 |
$42K |
| 11982 |
|
467 |
451 |
$40K |
| J3490 |
Drugs unclassified injection |
2,914 |
2,800 |
$33K |
| 11981 |
|
193 |
189 |
$20K |
| 86703 |
|
1,156 |
1,146 |
$14K |
| 81002 |
|
3,921 |
3,735 |
$13K |
| 58300 |
|
298 |
291 |
$10K |
| 87563 |
|
275 |
255 |
$6K |
| J7297 |
Liletta, 52 mg |
81 |
79 |
$5K |
| 58301 |
|
77 |
75 |
$3K |
| 99201 |
|
45 |
44 |
$1K |
| J0696 |
Ceftriaxone sodium injection |
1,484 |
1,433 |
$1K |
| J7303 |
Contraceptive vaginal ring |
75 |
71 |
$1K |
| 86780 |
|
40 |
39 |
$430.80 |
| Q3014 |
Telehealth facility fee |
12 |
12 |
$272.28 |