| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J7307 |
Etonogestrel (contraceptive) implant system, including implant and supplies |
1,520 |
1,487 |
$1.24M |
| S4993 |
Contraceptive pills for birth control |
3,812 |
3,761 |
$648K |
| 87491 |
|
10,368 |
10,252 |
$402K |
| 87591 |
|
10,361 |
10,247 |
$394K |
| 99214 |
|
5,002 |
4,476 |
$316K |
| 99213 |
|
5,979 |
4,952 |
$243K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
3,257 |
3,119 |
$221K |
| S0199 |
Medically induced abortion by oral ingestion of medication including all associated services and supplies (e.g., patient counseling, office visits, confirmation of pregnancy by hcg, ultrasound to confirm duration of pregnancy, ultrasound to confirm completion of abortion) except drugs |
356 |
349 |
$210K |
| J7304 |
Contraceptive supply, hormone containing patch, each |
197 |
193 |
$165K |
| J3490 |
Unclassified drugs |
6,416 |
6,178 |
$156K |
| 76817 |
|
1,963 |
1,644 |
$139K |
| A4267 |
Contraceptive supply, condom, male, each |
8,783 |
8,545 |
$101K |
| J7298 |
Levonorgestrel-releasing intrauterine contraceptive system (mirena), 52 mg |
103 |
102 |
$94K |
| 87806 |
|
3,394 |
3,351 |
$86K |
| 58300 |
|
906 |
437 |
$82K |
| 11981 |
|
466 |
442 |
$82K |
| 90651 |
|
298 |
294 |
$64K |
| 99212 |
|
2,143 |
1,904 |
$63K |
| Q0144 |
Azithromycin dihydrate, oral, capsules/powder, 1 gram |
2,165 |
2,117 |
$48K |
| 81025 |
|
13,804 |
13,091 |
$43K |
| 11976 |
|
726 |
355 |
$41K |
| 59840 |
|
150 |
80 |
$37K |
| 57454 |
|
512 |
255 |
$34K |
| S0190 |
Mifepristone, oral, 200 mg |
468 |
444 |
$30K |
| J7300 |
Intrauterine copper contraceptive (paragard) |
41 |
41 |
$28K |
| 99243 |
|
289 |
280 |
$19K |
| 99203 |
|
238 |
147 |
$15K |
| 99204 |
|
143 |
141 |
$15K |
| 99202 |
|
311 |
242 |
$14K |
| 90674 |
|
423 |
421 |
$14K |
| J7303 |
Contraceptive supply, hormone containing vaginal ring, each |
76 |
76 |
$13K |
| Q0111 |
Wet mounts, including preparations of vaginal, cervical or skin specimens |
2,920 |
2,853 |
$12K |
| 83986 |
|
2,922 |
2,853 |
$10K |
| 99211 |
|
474 |
452 |
$9K |
| 99000 |
|
3,378 |
3,108 |
$9K |
| 58301 |
|
297 |
142 |
$9K |
| Q3014 |
Telehealth originating site facility fee |
214 |
211 |
$5K |
| 81002 |
|
1,123 |
1,094 |
$3K |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
381 |
374 |
$2K |
| S0191 |
Misoprostol, oral, 200 mcg |
527 |
503 |
$2K |
| 85018 |
|
514 |
497 |
$1K |
| 90471 |
|
448 |
443 |
$799.46 |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
140 |
140 |
$743.99 |
| S0197 |
Prenatal vitamins, 30-day supply |
205 |
195 |
$229.83 |
| 86901 |
|
93 |
93 |
$209.75 |
| S5000 |
Prescription drug, generic |
2,427 |
1,998 |
$8.00 |
| S5001 |
Prescription drug, brand name |
509 |
502 |
$2.00 |