| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J3490 |
Drugs unclassified injection |
13,119 |
10,758 |
$602K |
| S4993 |
Contraceptive pills for bc |
3,554 |
3,516 |
$410K |
| 99212 |
|
4,728 |
4,647 |
$327K |
| 99213 |
|
3,682 |
3,599 |
$311K |
| J7307 |
Etonogestrel implant system |
303 |
302 |
$300K |
| 99211 |
|
6,603 |
6,468 |
$281K |
| 99202 |
|
1,804 |
1,799 |
$213K |
| 99201 |
|
2,369 |
2,342 |
$200K |
| 99203 |
|
900 |
900 |
$190K |
| S0199 |
Med abortion inc all ex drug |
370 |
369 |
$189K |
| 87806 |
|
4,583 |
4,116 |
$110K |
| A4267 |
Male condom |
6,760 |
6,668 |
$83K |
| 11981 |
|
283 |
283 |
$65K |
| 99214 |
|
502 |
496 |
$64K |
| J7304 |
Contraceptive hormone patch |
64 |
64 |
$44K |
| T1999 |
Noc retail items andsupplies |
2,066 |
1,443 |
$30K |
| 87661 |
|
870 |
866 |
$26K |
| 76815 |
|
367 |
357 |
$21K |
| 99204 |
|
81 |
81 |
$21K |
| S0190 |
Mifepristone, oral, 200 mg |
338 |
336 |
$20K |
| 99000 |
|
3,976 |
3,923 |
$16K |
| 58300 |
|
112 |
58 |
$13K |
| 81025 |
|
4,568 |
4,518 |
$13K |
| S9445 |
Pt education noc individ |
941 |
941 |
$12K |
| 11976 |
|
98 |
50 |
$7K |
| J7303 |
Contraceptive vaginal ring |
24 |
24 |
$5K |
| Q0111 |
Wet mounts/ w preparations |
1,433 |
1,416 |
$5K |
| 83986 |
|
1,673 |
1,537 |
$5K |
| S5000 |
Prescription drug, generic |
493 |
478 |
$4K |
| Q0144 |
Azithromycin dihydrate, oral |
430 |
411 |
$2K |
| 58301 |
|
46 |
24 |
$2K |
| 87591 |
|
139 |
138 |
$1K |
| 99401 |
|
68 |
68 |
$1K |
| S0191 |
Misoprostol, oral, 200 mcg |
381 |
376 |
$1K |
| 87491 |
|
97 |
97 |
$592.23 |
| 85018 |
|
192 |
183 |
$483.64 |
| 81002 |
|
204 |
204 |
$406.01 |
| 86901 |
|
48 |
48 |
$95.94 |