| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J3490 |
Drugs unclassified injection |
8,378 |
6,776 |
$423K |
| 99213 |
|
4,042 |
3,936 |
$382K |
| S0199 |
Med abortion inc all ex drug |
655 |
655 |
$329K |
| S4993 |
Contraceptive pills for bc |
2,155 |
2,100 |
$274K |
| 99202 |
|
1,933 |
1,925 |
$230K |
| J7307 |
Etonogestrel implant system |
195 |
195 |
$226K |
| 99212 |
|
3,342 |
3,233 |
$203K |
| 99214 |
|
1,088 |
1,062 |
$154K |
| 99203 |
|
765 |
762 |
$149K |
| 87806 |
|
5,393 |
4,747 |
$136K |
| 99211 |
|
2,779 |
2,712 |
$95K |
| A4267 |
Male condom |
3,539 |
3,522 |
$92K |
| 99201 |
|
593 |
589 |
$59K |
| 87661 |
|
1,853 |
1,837 |
$55K |
| 11981 |
|
181 |
181 |
$50K |
| 58300 |
|
321 |
164 |
$44K |
| 87491 |
|
1,324 |
1,315 |
$41K |
| 87591 |
|
1,314 |
1,305 |
$40K |
| S0190 |
Mifepristone, oral, 200 mg |
619 |
618 |
$36K |
| 99204 |
|
153 |
153 |
$35K |
| 76815 |
|
388 |
377 |
$22K |
| J7304 |
Contraceptive hormone patch |
27 |
27 |
$22K |
| S9445 |
Pt education noc individ |
1,604 |
1,604 |
$20K |
| 99401 |
|
1,021 |
994 |
$19K |
| 81025 |
|
4,141 |
4,082 |
$15K |
| 99000 |
|
3,953 |
3,853 |
$12K |
| J8499 |
Oral prescrip drug non chemo |
706 |
452 |
$10K |
| 99402 |
|
279 |
276 |
$9K |
| S5000 |
Prescription drug, generic |
1,098 |
959 |
$9K |
| J1050 |
Medroxyprogesterone acetate |
91 |
91 |
$7K |
| Q0111 |
Wet mounts/ w preparations |
1,754 |
1,703 |
$7K |
| 83986 |
|
2,118 |
1,918 |
$6K |
| 11982 |
|
76 |
38 |
$5K |
| 58301 |
|
103 |
52 |
$4K |
| 85018 |
|
212 |
204 |
$2K |
| S0191 |
Misoprostol, oral, 200 mcg |
694 |
676 |
$2K |
| 11976 |
|
24 |
12 |
$1K |
| 99403 |
|
29 |
29 |
$1K |
| Q3014 |
Telehealth facility fee |
53 |
51 |
$1K |
| Q0144 |
Azithromycin dihydrate, oral |
226 |
198 |
$716.51 |
| G2012 |
Brief check in by md/qhp |
59 |
58 |
$695.78 |
| 81002 |
|
287 |
280 |
$594.79 |
| J4390 |
|
31 |
12 |
$220.00 |
| J0696 |
Ceftriaxone sodium injection |
13 |
13 |
$75.06 |
| T1014 |
Telehealth transmit, per min |
50 |
50 |
$67.92 |