| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
|
6,405 |
6,048 |
$594K |
| S0199 |
Med abortion inc all ex drug |
1,078 |
1,062 |
$542K |
| J3490 |
Drugs unclassified injection |
10,306 |
8,447 |
$431K |
| S4993 |
Contraceptive pills for bc |
2,473 |
2,446 |
$310K |
| 99214 |
|
1,984 |
1,952 |
$268K |
| 99202 |
|
2,032 |
2,020 |
$261K |
| J7307 |
Etonogestrel implant system |
245 |
245 |
$241K |
| 99212 |
|
3,088 |
3,025 |
$203K |
| 87806 |
|
6,344 |
5,455 |
$153K |
| 99211 |
|
4,094 |
3,895 |
$122K |
| 99203 |
|
499 |
497 |
$116K |
| 99201 |
|
1,414 |
1,409 |
$96K |
| 76815 |
|
1,320 |
1,231 |
$79K |
| S0190 |
Mifepristone, oral, 200 mg |
1,075 |
1,056 |
$64K |
| T1999 |
Noc retail items andsupplies |
3,568 |
2,316 |
$56K |
| A4267 |
Male condom |
5,010 |
4,918 |
$53K |
| 11981 |
|
213 |
213 |
$52K |
| 99204 |
|
199 |
199 |
$51K |
| 58300 |
|
481 |
248 |
$48K |
| 87661 |
|
1,317 |
1,311 |
$39K |
| 99401 |
|
1,514 |
1,485 |
$29K |
| 99000 |
|
4,857 |
4,722 |
$19K |
| 81025 |
|
5,027 |
4,910 |
$15K |
| 11976 |
|
222 |
115 |
$13K |
| J7298 |
Mirena, 52 mg |
15 |
15 |
$12K |
| 83986 |
|
4,197 |
3,665 |
$12K |
| Q0111 |
Wet mounts/ w preparations |
3,257 |
3,180 |
$11K |
| 99402 |
|
354 |
354 |
$11K |
| 58301 |
|
266 |
141 |
$8K |
| S5000 |
Prescription drug, generic |
1,047 |
1,008 |
$8K |
| S0191 |
Misoprostol, oral, 200 mcg |
1,120 |
1,089 |
$4K |
| 85018 |
|
711 |
675 |
$3K |
| 99001 |
|
481 |
474 |
$3K |
| Q0144 |
Azithromycin dihydrate, oral |
421 |
400 |
$2K |
| S9445 |
Pt education noc individ |
154 |
154 |
$2K |
| G2012 |
Brief check in by md/qhp |
149 |
145 |
$2K |
| 87591 |
|
48 |
47 |
$2K |
| 81002 |
|
694 |
678 |
$1K |
| 87491 |
|
14 |
14 |
$367.81 |
| J0696 |
Ceftriaxone sodium injection |
56 |
53 |
$280.06 |
| 0270 |
|
43 |
28 |
$253.95 |
| 98966 |
|
14 |
14 |
$128.80 |
| 86901 |
|
29 |
29 |
$66.42 |