| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S4993 |
Contraceptive pills for birth control |
1,698 |
1,555 |
$129K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
2,723 |
2,340 |
$119K |
| J7307 |
Etonogestrel (contraceptive) implant system, including implant and supplies |
86 |
81 |
$46K |
| 59430 |
|
935 |
843 |
$39K |
| 96372 |
|
2,727 |
2,339 |
$24K |
| 99395 |
|
556 |
474 |
$22K |
| 99212 |
|
1,554 |
1,399 |
$20K |
| 99213 |
|
610 |
570 |
$13K |
| 81025 |
|
2,889 |
2,547 |
$11K |
| 99000 |
|
619 |
560 |
$5K |
| A4269 |
Contraceptive supply, spermicide (e.g., foam, gel), each |
716 |
651 |
$5K |
| 11982 |
|
72 |
69 |
$5K |
| A4267 |
Contraceptive supply, condom, male, each |
1,015 |
907 |
$4K |
| 85013 |
|
2,730 |
2,428 |
$4K |
| 99385 |
|
61 |
54 |
$3K |
| 11981 |
|
53 |
52 |
$2K |
| 90651 |
|
16 |
14 |
$875.15 |
| 87086 |
|
159 |
140 |
$670.72 |
| 86762 |
|
50 |
45 |
$456.62 |
| 87210 |
|
149 |
136 |
$437.91 |
| 90688 |
|
37 |
36 |
$352.17 |
| 90471 |
|
81 |
76 |
$327.71 |
| A9150 |
Non-prescription drugs |
25 |
24 |
$222.60 |
| 81002 |
|
121 |
106 |
$205.56 |
| 99211 |
|
12 |
12 |
$140.15 |
| J3490 |
Unclassified drugs |
28 |
24 |
$0.00 |