| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0199 |
Med abortion inc all ex drug |
8,911 |
8,842 |
$7.16M |
| 99215 |
Prolong outpt/office vis |
12,582 |
11,386 |
$1.01M |
| 76857 |
|
9,772 |
9,520 |
$618K |
| 99205 |
Prolong outpt/office vis |
1,681 |
1,639 |
$228K |
| S4993 |
Contraceptive pills for bc |
3,013 |
2,779 |
$140K |
| J3490 |
Drugs unclassified injection |
3,337 |
3,111 |
$99K |
| H0033 |
Oral med adm direct observe |
189 |
167 |
$59K |
| A4267 |
Male condom |
4,139 |
3,877 |
$56K |
| 81025 |
|
10,785 |
10,562 |
$43K |
| 99202 |
|
1,203 |
1,011 |
$34K |
| 86901 |
|
9,200 |
9,121 |
$31K |
| 85013 |
|
9,194 |
9,118 |
$26K |
| 99214 |
|
157 |
150 |
$11K |
| S0190 |
Mifepristone, oral, 200 mg |
98 |
97 |
$9K |
| 99000 |
|
1,016 |
895 |
$5K |
| Q0144 |
Azithromycin dihydrate, oral |
140 |
135 |
$5K |
| 86328 |
|
103 |
100 |
$4K |
| 86769 |
|
86 |
84 |
$3K |
| J1000 |
Depo-estradiol cypionate inj |
76 |
69 |
$3K |
| 99213 |
|
39 |
38 |
$2K |
| 87801 |
|
28 |
25 |
$2K |
| 86900 |
|
151 |
149 |
$525.50 |
| 85018 |
|
149 |
148 |
$454.06 |
| S0191 |
Misoprostol, oral, 200 mcg |
16 |
13 |
$59.16 |
| 81005 |
|
16 |
15 |
$42.56 |