| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J7307 |
Etonogestrel implant system |
1,287 |
1,272 |
$1.06M |
| S4993 |
Contraceptive pills for bc |
3,666 |
3,581 |
$689K |
| 87491 |
|
14,023 |
13,729 |
$624K |
| 87591 |
|
14,027 |
13,731 |
$607K |
| 99214 |
|
9,569 |
8,529 |
$518K |
| 99213 |
|
12,987 |
10,989 |
$413K |
| J7304 |
Contraceptive hormone patch |
383 |
364 |
$336K |
| 90651 |
|
1,139 |
1,114 |
$265K |
| J1050 |
Medroxyprogesterone acetate |
3,755 |
3,547 |
$254K |
| S0199 |
Med abortion inc all ex drug |
318 |
314 |
$184K |
| 99395 |
|
1,456 |
1,348 |
$138K |
| J3490 |
Drugs unclassified injection |
5,295 |
5,013 |
$131K |
| A4267 |
Male condom |
10,996 |
10,460 |
$129K |
| 11981 |
|
530 |
515 |
$105K |
| 87806 |
|
4,091 |
4,036 |
$87K |
| 11976 |
|
1,244 |
610 |
$80K |
| 99212 |
|
2,668 |
2,412 |
$69K |
| 90674 |
|
1,750 |
1,699 |
$53K |
| 81025 |
|
17,976 |
16,642 |
$53K |
| 99204 |
|
475 |
464 |
$48K |
| Q3014 |
Telehealth facility fee |
2,697 |
2,503 |
$47K |
| 96156 |
|
675 |
650 |
$45K |
| 58300 |
|
398 |
196 |
$43K |
| 99203 |
|
451 |
368 |
$32K |
| 99385 |
|
180 |
160 |
$16K |
| S0190 |
Mifepristone, oral, 200 mg |
226 |
223 |
$16K |
| 99202 |
|
323 |
265 |
$15K |
| J7298 |
Mirena, 52 mg |
14 |
14 |
$12K |
| J7303 |
Contraceptive vaginal ring |
62 |
61 |
$12K |
| Q0111 |
Wet mounts/ w preparations |
2,865 |
2,790 |
$11K |
| 99211 |
|
695 |
657 |
$11K |
| 83986 |
|
2,867 |
2,792 |
$9K |
| 99000 |
|
3,134 |
3,060 |
$8K |
| 58301 |
|
257 |
115 |
$8K |
| Q0144 |
Azithromycin dihydrate, oral |
1,437 |
1,401 |
$7K |
| 90715 |
|
139 |
138 |
$6K |
| 90471 |
|
2,571 |
2,481 |
$5K |
| 81002 |
|
1,545 |
1,497 |
$3K |
| G8431 |
Pos clin depres scrn f/u doc |
240 |
237 |
$3K |
| J0696 |
Ceftriaxone sodium injection |
507 |
489 |
$3K |
| 96150 |
|
251 |
250 |
$2K |
| 83036 |
|
915 |
906 |
$2K |
| 96127 |
|
494 |
473 |
$2K |
| 86580 |
|
138 |
132 |
$1K |
| U0003 |
Cov-19 amp prb hgh thruput |
14 |
13 |
$1K |
| 76817 |
|
12 |
12 |
$1K |
| 90746 |
|
12 |
12 |
$886.40 |
| S0191 |
Misoprostol, oral, 200 mcg |
230 |
224 |
$794.20 |
| G0442 |
Annual alcohol screen 15 min |
106 |
105 |
$548.28 |
| 85018 |
|
637 |
623 |
$532.59 |
| G0444 |
Depression screen annual |
64 |
61 |
$170.19 |
| 87430 |
|
12 |
12 |
$130.95 |
| 96151 |
|
31 |
31 |
$48.66 |
| S5001 |
Prescription drug,brand name |
392 |
391 |
$1.18 |
| G8510 |
Scr dep neg, no plan reqd |
397 |
397 |
$1.05 |
| 3078F |
|
797 |
797 |
$0.00 |
| S5000 |
Prescription drug, generic |
2,834 |
2,263 |
$0.00 |
| 1160F |
|
1,181 |
1,181 |
$0.00 |
| 1159F |
|
1,181 |
1,181 |
$0.00 |
| G8783 |
Bp scrn perf rec interval |
129 |
126 |
$0.00 |
| G8417 |
Calc bmi abv up param f/u |
37 |
37 |
$0.00 |
| 99442 |
|
60 |
52 |
$0.00 |
| 2000F |
|
842 |
841 |
$0.00 |
| 3074F |
|
833 |
833 |
$0.00 |
| 1036F |
|
929 |
929 |
$0.00 |
| 3008F |
|
552 |
552 |
$0.00 |
| 99441 |
|
13 |
13 |
$0.00 |