| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J7307 |
Etonogestrel implant system |
494 |
491 |
$408K |
| S4993 |
Contraceptive pills for bc |
1,288 |
1,284 |
$192K |
| 87491 |
|
2,736 |
2,727 |
$103K |
| 99213 |
|
2,562 |
1,970 |
$103K |
| 87591 |
|
2,735 |
2,726 |
$102K |
| J1050 |
Medroxyprogesterone acetate |
950 |
946 |
$66K |
| J3490 |
Drugs unclassified injection |
1,847 |
1,812 |
$44K |
| 99214 |
|
632 |
520 |
$40K |
| J7304 |
Contraceptive hormone patch |
26 |
26 |
$26K |
| 57454 |
|
358 |
179 |
$24K |
| A4267 |
Male condom |
2,056 |
2,016 |
$24K |
| 87806 |
|
934 |
923 |
$24K |
| 99212 |
|
718 |
569 |
$20K |
| S0199 |
Med abortion inc all ex drug |
32 |
32 |
$19K |
| 90651 |
|
63 |
62 |
$14K |
| Q0144 |
Azithromycin dihydrate, oral |
666 |
651 |
$13K |
| 76817 |
|
155 |
135 |
$12K |
| 81025 |
|
3,551 |
3,449 |
$11K |
| 11981 |
|
58 |
58 |
$9K |
| 90674 |
|
163 |
161 |
$5K |
| 11976 |
|
78 |
39 |
$5K |
| S0190 |
Mifepristone, oral, 200 mg |
39 |
39 |
$3K |
| 99203 |
|
41 |
32 |
$3K |
| Q0111 |
Wet mounts/ w preparations |
620 |
616 |
$3K |
| 83986 |
|
619 |
616 |
$2K |
| 99211 |
|
78 |
78 |
$2K |
| 99000 |
|
598 |
582 |
$1K |
| 90471 |
|
161 |
159 |
$325.58 |
| 81002 |
|
113 |
113 |
$274.89 |
| S0191 |
Misoprostol, oral, 200 mcg |
39 |
39 |
$123.48 |
| 85018 |
|
16 |
15 |
$37.68 |
| S5000 |
Prescription drug, generic |
245 |
235 |
$0.00 |
| S5001 |
Prescription drug,brand name |
14 |
14 |
$0.00 |