| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J3490 |
Drugs unclassified injection |
3,435 |
2,965 |
$132K |
| J7307 |
Etonogestrel implant system |
127 |
127 |
$105K |
| S4993 |
Contraceptive pills for bc |
959 |
957 |
$91K |
| 99213 |
|
572 |
528 |
$77K |
| 58300 |
|
716 |
360 |
$70K |
| 99212 |
|
519 |
516 |
$54K |
| 99214 |
|
234 |
230 |
$51K |
| 99211 |
|
629 |
564 |
$41K |
| 87806 |
|
1,251 |
971 |
$32K |
| 11981 |
|
128 |
127 |
$25K |
| 99202 |
|
123 |
123 |
$24K |
| 55250 |
|
100 |
50 |
$15K |
| 59840 |
|
71 |
36 |
$15K |
| A4267 |
Male condom |
2,231 |
2,223 |
$12K |
| 99401 |
|
535 |
532 |
$10K |
| J7298 |
Mirena, 52 mg |
12 |
12 |
$8K |
| 99203 |
|
28 |
25 |
$8K |
| S9445 |
Pt education noc individ |
382 |
382 |
$5K |
| 81025 |
|
1,384 |
1,348 |
$5K |
| 99201 |
|
27 |
27 |
$4K |
| 76817 |
|
41 |
40 |
$3K |
| 99000 |
|
751 |
745 |
$3K |
| 83986 |
|
970 |
851 |
$3K |
| S5000 |
Prescription drug, generic |
420 |
405 |
$3K |
| Q0111 |
Wet mounts/ w preparations |
622 |
615 |
$2K |
| 86703 |
|
157 |
114 |
$2K |
| Q0144 |
Azithromycin dihydrate, oral |
324 |
322 |
$1K |
| J7030 |
Normal saline solution infus |
76 |
76 |
$1K |
| 87491 |
|
40 |
39 |
$882.32 |
| 87591 |
|
40 |
39 |
$877.15 |
| 85018 |
|
267 |
264 |
$509.24 |
| J3010 |
Fentanyl citrate injection |
54 |
54 |
$264.93 |
| 86901 |
|
98 |
94 |
$225.20 |
| 81002 |
|
27 |
26 |
$47.13 |
| 82120 |
|
13 |
12 |
$47.13 |
| 87210 |
|
13 |
12 |
$41.80 |
| S0191 |
Misoprostol, oral, 200 mcg |
13 |
12 |
$35.38 |