| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
|
10,663 |
10,005 |
$1.25M |
| 99214 |
|
6,262 |
5,711 |
$1.13M |
| S4993 |
Contraceptive pills for bc |
6,026 |
5,907 |
$738K |
| 99212 |
|
7,049 |
6,125 |
$582K |
| 87806 |
|
19,621 |
15,266 |
$495K |
| 99203 |
|
1,551 |
1,506 |
$452K |
| J7307 |
Etonogestrel implant system |
420 |
396 |
$357K |
| 99202 |
|
1,794 |
1,651 |
$324K |
| J3490 |
Drugs unclassified injection |
6,702 |
5,584 |
$303K |
| 99201 |
|
1,595 |
1,304 |
$159K |
| 99211 |
|
1,489 |
1,469 |
$92K |
| 11981 |
|
394 |
393 |
$88K |
| J7303 |
Contraceptive vaginal ring |
281 |
278 |
$59K |
| 58300 |
|
574 |
306 |
$55K |
| 81025 |
|
13,214 |
12,783 |
$42K |
| 99000 |
|
8,860 |
8,568 |
$32K |
| S5000 |
Prescription drug, generic |
4,605 |
4,338 |
$30K |
| A4267 |
Male condom |
3,390 |
3,369 |
$29K |
| 11976 |
|
256 |
254 |
$27K |
| S0199 |
Med abortion inc all ex drug |
50 |
50 |
$26K |
| S9445 |
Pt education noc individ |
2,002 |
2,002 |
$25K |
| J7298 |
Mirena, 52 mg |
13 |
12 |
$15K |
| 83986 |
|
5,285 |
4,443 |
$14K |
| J7304 |
Contraceptive hormone patch |
25 |
25 |
$10K |
| 87210 |
|
3,027 |
2,942 |
$9K |
| Q0144 |
Azithromycin dihydrate, oral |
1,137 |
715 |
$6K |
| 58301 |
|
181 |
100 |
$6K |
| 86701 |
|
807 |
603 |
$5K |
| 99204 |
|
12 |
12 |
$4K |
| S5199 |
Personal care item nos each |
710 |
709 |
$3K |
| 87491 |
|
72 |
72 |
$2K |
| 87591 |
|
72 |
72 |
$2K |
| 81002 |
|
1,047 |
1,028 |
$2K |
| 99401 |
|
95 |
95 |
$2K |
| S0190 |
Mifepristone, oral, 200 mg |
26 |
26 |
$2K |
| J1050 |
Medroxyprogesterone acetate |
20 |
20 |
$2K |
| 76817 |
|
53 |
52 |
$878.22 |
| J0696 |
Ceftriaxone sodium injection |
40 |
40 |
$143.72 |
| S0191 |
Misoprostol, oral, 200 mcg |
42 |
39 |
$115.30 |
| 85018 |
|
73 |
71 |
$44.45 |
| 36415 |
|
13 |
12 |
$30.00 |
| 86901 |
|
17 |
17 |
$0.00 |