| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99212 |
|
1,829 |
1,788 |
$96K |
| J7304 |
Contraceptive hormone patch |
15 |
15 |
$38K |
| 87806 |
|
1,123 |
1,002 |
$27K |
| A4267 |
Male condom |
1,089 |
1,080 |
$26K |
| J3490 |
Drugs unclassified injection |
689 |
607 |
$14K |
| 99213 |
|
214 |
205 |
$14K |
| S0199 |
Med abortion inc all ex drug |
32 |
32 |
$12K |
| 90651 |
|
39 |
39 |
$11K |
| 87491 |
|
234 |
234 |
$7K |
| 87591 |
|
245 |
245 |
$7K |
| 81025 |
|
1,381 |
1,333 |
$4K |
| T1014 |
Telehealth transmit, per min |
1,334 |
1,312 |
$4K |
| 99214 |
|
18 |
18 |
$2K |
| S0190 |
Mifepristone, oral, 200 mg |
35 |
35 |
$1K |
| G9920 |
Scrning perf and negative |
31 |
31 |
$899.00 |
| 86592 |
|
169 |
164 |
$591.06 |
| 86703 |
|
15 |
13 |
$160.24 |
| Q0144 |
Azithromycin dihydrate, oral |
12 |
12 |
$52.14 |
| S0191 |
Misoprostol, oral, 200 mcg |
20 |
20 |
$8.49 |