| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J7307 |
Etonogestrel implant system |
1,136 |
1,128 |
$1.03M |
| J3490 |
Drugs unclassified injection |
16,779 |
13,636 |
$810K |
| S4993 |
Contraceptive pills for bc |
4,512 |
4,465 |
$566K |
| 99213 |
|
6,736 |
6,474 |
$564K |
| 99211 |
|
14,182 |
13,379 |
$465K |
| J7304 |
Contraceptive hormone patch |
454 |
449 |
$443K |
| S0199 |
Med abortion inc all ex drug |
795 |
791 |
$401K |
| 99214 |
|
3,049 |
2,981 |
$368K |
| 99212 |
|
4,488 |
4,405 |
$284K |
| 99202 |
|
2,044 |
2,023 |
$232K |
| 11981 |
|
1,004 |
997 |
$232K |
| 87806 |
|
7,794 |
6,957 |
$187K |
| 99201 |
|
2,311 |
2,288 |
$183K |
| 99203 |
|
740 |
740 |
$139K |
| A4267 |
Male condom |
8,176 |
8,065 |
$116K |
| 76815 |
|
1,335 |
1,296 |
$81K |
| T1999 |
Noc retail items andsupplies |
4,579 |
3,296 |
$76K |
| 58300 |
|
681 |
349 |
$70K |
| 11976 |
|
1,100 |
577 |
$65K |
| S0190 |
Mifepristone, oral, 200 mg |
826 |
817 |
$50K |
| 99401 |
|
1,821 |
1,731 |
$35K |
| 11982 |
|
537 |
283 |
$35K |
| 99000 |
|
7,333 |
7,178 |
$32K |
| 81025 |
|
8,544 |
8,433 |
$25K |
| 87661 |
|
903 |
903 |
$23K |
| J7303 |
Contraceptive vaginal ring |
80 |
80 |
$22K |
| 99204 |
|
60 |
60 |
$17K |
| 58301 |
|
460 |
238 |
$15K |
| 83986 |
|
5,270 |
4,686 |
$15K |
| Q0111 |
Wet mounts/ w preparations |
3,953 |
3,863 |
$14K |
| S9445 |
Pt education noc individ |
1,026 |
1,026 |
$13K |
| J7300 |
Intra copp contra (paragard) |
12 |
12 |
$9K |
| S5000 |
Prescription drug, generic |
1,136 |
1,084 |
$8K |
| Q0144 |
Azithromycin dihydrate, oral |
1,237 |
1,170 |
$6K |
| G2012 |
Brief check in by md/qhp |
337 |
330 |
$4K |
| 87591 |
|
416 |
414 |
$4K |
| S0191 |
Misoprostol, oral, 200 mcg |
835 |
821 |
$2K |
| 85018 |
|
570 |
561 |
$2K |
| J0696 |
Ceftriaxone sodium injection |
316 |
304 |
$2K |
| 86901 |
|
197 |
196 |
$1K |
| 87491 |
|
325 |
323 |
$897.70 |
| J0561 |
Penicillin g benzathine inj |
58 |
42 |
$661.94 |
| 81002 |
|
327 |
324 |
$618.36 |
| 99402 |
|
16 |
16 |
$508.64 |