| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 87491 |
|
105,043 |
104,713 |
$3.06M |
| 87591 |
|
105,023 |
104,697 |
$2.71M |
| 87806 |
|
26,079 |
22,662 |
$524K |
| 81025 |
|
45,489 |
43,179 |
$134K |
| 99212 |
|
2,840 |
2,696 |
$102K |
| S0199 |
Med abortion inc all ex drug |
315 |
308 |
$92K |
| A4267 |
Male condom |
1,607 |
1,585 |
$67K |
| J3490 |
Drugs unclassified injection |
1,410 |
1,259 |
$60K |
| 99000 |
|
3,135 |
3,132 |
$27K |
| 87800 |
|
1,418 |
1,417 |
$27K |
| Q0144 |
Azithromycin dihydrate, oral |
413 |
406 |
$24K |
| 87661 |
|
1,388 |
1,382 |
$23K |
| 87799 |
|
774 |
772 |
$16K |
| 87481 |
|
766 |
764 |
$15K |
| 59840 |
|
145 |
85 |
$15K |
| 85018 |
|
2,222 |
2,169 |
$9K |
| 99213 |
|
297 |
291 |
$8K |
| 87563 |
|
294 |
293 |
$6K |
| 81002 |
|
2,044 |
2,024 |
$4K |
| 86592 |
|
1,329 |
1,327 |
$4K |
| 86901 |
|
1,217 |
1,200 |
$3K |
| 99202 |
|
29 |
29 |
$2K |
| S0191 |
Misoprostol, oral, 200 mcg |
66 |
66 |
$2K |
| 76817 |
|
72 |
69 |
$1K |
| G9920 |
Scrning perf and negative |
120 |
116 |
$1K |
| S0190 |
Mifepristone, oral, 200 mg |
51 |
51 |
$1K |
| Q0111 |
Wet mounts/ w preparations |
37 |
37 |
$0.00 |