| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
|
9,228 |
8,898 |
$805K |
| S4993 |
Contraceptive pills for bc |
6,691 |
6,538 |
$732K |
| J3490 |
Drugs unclassified injection |
15,590 |
14,006 |
$729K |
| S0199 |
Med abortion inc all ex drug |
1,121 |
1,103 |
$695K |
| J7307 |
Etonogestrel implant system |
613 |
565 |
$659K |
| 99212 |
|
6,797 |
6,522 |
$435K |
| 87806 |
|
14,950 |
13,425 |
$411K |
| 99214 |
|
2,212 |
2,174 |
$326K |
| 99211 |
|
7,196 |
7,034 |
$314K |
| 99202 |
|
2,452 |
2,377 |
$273K |
| 59840 |
|
1,001 |
636 |
$205K |
| 99201 |
|
1,829 |
1,821 |
$170K |
| 58300 |
|
1,090 |
625 |
$124K |
| A4267 |
Male condom |
10,643 |
10,357 |
$116K |
| 99203 |
|
659 |
657 |
$113K |
| 11981 |
|
483 |
442 |
$106K |
| 0520 |
|
670 |
333 |
$95K |
| S0190 |
Mifepristone, oral, 200 mg |
1,005 |
980 |
$69K |
| 76817 |
|
831 |
810 |
$66K |
| J7303 |
Contraceptive vaginal ring |
98 |
94 |
$63K |
| S9445 |
Pt education noc individ |
3,110 |
3,110 |
$40K |
| 81025 |
|
12,328 |
11,995 |
$38K |
| 11976 |
|
560 |
280 |
$35K |
| J7300 |
Intra copp contra (paragard) |
39 |
39 |
$34K |
| 86780 |
|
2,889 |
2,886 |
$33K |
| A4649 |
Surgical supplies |
2,268 |
1,914 |
$30K |
| 86703 |
|
2,610 |
2,319 |
$28K |
| J7298 |
Mirena, 52 mg |
24 |
24 |
$23K |
| S5000 |
Prescription drug, generic |
2,174 |
2,048 |
$23K |
| 87591 |
|
732 |
680 |
$21K |
| 87491 |
|
695 |
645 |
$20K |
| 99152 |
|
368 |
362 |
$20K |
| 86803 |
|
1,150 |
1,147 |
$17K |
| J7297 |
Liletta, 52 mg |
14 |
12 |
$14K |
| Q0144 |
Azithromycin dihydrate, oral |
1,669 |
1,314 |
$10K |
| 83986 |
|
3,101 |
2,745 |
$10K |
| J7304 |
Contraceptive hormone patch |
12 |
12 |
$10K |
| 87808 |
|
864 |
835 |
$9K |
| 87624 |
|
254 |
194 |
$9K |
| 58301 |
|
258 |
131 |
$9K |
| 99000 |
|
1,977 |
1,960 |
$8K |
| 87210 |
|
2,013 |
1,723 |
$7K |
| J7295 |
Eth estr and eton monthly |
12 |
12 |
$7K |
| 99402 |
|
176 |
176 |
$6K |
| 99395 |
|
43 |
43 |
$5K |
| 64435 |
|
155 |
141 |
$5K |
| Q0111 |
Wet mounts/ w preparations |
1,008 |
962 |
$4K |
| 85018 |
|
1,059 |
979 |
$2K |
| 11982 |
|
32 |
16 |
$2K |
| 90674 |
|
59 |
57 |
$2K |
| 81002 |
|
780 |
753 |
$2K |
| S0191 |
Misoprostol, oral, 200 mcg |
1,222 |
1,174 |
$1K |
| 0300 |
|
140 |
91 |
$921.79 |
| 88142 |
|
69 |
69 |
$823.46 |
| 86901 |
|
316 |
302 |
$733.09 |
| 86592 |
|
129 |
129 |
$524.81 |
| 99401 |
|
50 |
50 |
$447.50 |
| 96372 |
|
12 |
12 |
$269.51 |
| J0696 |
Ceftriaxone sodium injection |
39 |
37 |
$216.27 |
| 90471 |
|
34 |
33 |
$155.15 |
| 86701 |
|
14 |
14 |
$101.42 |
| S0119 |
Ondansetron 4 mg |
62 |
62 |
$21.45 |