| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J3490 |
Unclassified drugs |
9,594 |
7,915 |
$363K |
| S4993 |
Contraceptive pills for birth control |
3,060 |
3,052 |
$354K |
| 99212 |
|
2,845 |
2,804 |
$253K |
| 99202 |
|
793 |
793 |
$154K |
| 99401 |
|
6,203 |
6,089 |
$118K |
| 99211 |
|
1,792 |
1,669 |
$80K |
| 99213 |
|
566 |
560 |
$72K |
| 87806 |
|
2,473 |
1,820 |
$62K |
| 99203 |
|
139 |
139 |
$45K |
| J7304 |
Contraceptive supply, hormone containing patch, each |
120 |
120 |
$32K |
| A4267 |
Contraceptive supply, condom, male, each |
5,183 |
5,115 |
$29K |
| S9445 |
Patient education, not otherwise classified, non-physician provider, individual, per session |
1,783 |
1,783 |
$23K |
| 99201 |
|
192 |
192 |
$20K |
| 81025 |
|
4,167 |
4,114 |
$13K |
| J7307 |
Etonogestrel (contraceptive) implant system, including implant and supplies |
16 |
16 |
$13K |
| 87491 |
|
362 |
353 |
$12K |
| J7303 |
Contraceptive supply, hormone containing vaginal ring, each |
135 |
135 |
$9K |
| 87591 |
|
373 |
364 |
$5K |
| 99402 |
|
112 |
112 |
$4K |
| 11981 |
|
16 |
16 |
$3K |
| Q0144 |
Azithromycin dihydrate, oral, capsules/powder, 1 gram |
809 |
793 |
$3K |
| 86703 |
|
259 |
203 |
$3K |
| 99000 |
|
549 |
544 |
$2K |
| S5000 |
Prescription drug, generic |
80 |
80 |
$973.49 |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
19 |
16 |
$106.44 |
| 86592 |
|
12 |
12 |
$21.86 |