| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 87491 |
|
25,662 |
25,195 |
$753K |
| 87591 |
|
25,594 |
25,140 |
$716K |
| 99214 |
|
9,001 |
8,397 |
$495K |
| A4267 |
Male condom |
11,740 |
11,187 |
$379K |
| S0199 |
Med abortion inc all ex drug |
798 |
795 |
$343K |
| 99213 |
|
8,892 |
8,420 |
$279K |
| 11981 |
|
877 |
874 |
$143K |
| 87806 |
|
7,418 |
7,356 |
$141K |
| 99204 |
|
1,124 |
1,121 |
$117K |
| 99212 |
|
3,667 |
3,571 |
$103K |
| 99203 |
|
881 |
879 |
$78K |
| 81025 |
|
25,084 |
23,071 |
$59K |
| 11976 |
|
1,234 |
667 |
$56K |
| 76817 |
|
756 |
621 |
$53K |
| 99202 |
|
999 |
998 |
$48K |
| 58300 |
|
575 |
303 |
$44K |
| 90651 |
|
165 |
165 |
$33K |
| S4993 |
Contraceptive pills for bc |
722 |
715 |
$33K |
| S0190 |
Mifepristone, oral, 200 mg |
608 |
608 |
$29K |
| 99211 |
|
1,113 |
1,091 |
$24K |
| 99000 |
|
6,936 |
6,640 |
$20K |
| Q0111 |
Wet mounts/ w preparations |
4,833 |
4,650 |
$15K |
| J7307 |
Etonogestrel implant system |
14 |
14 |
$12K |
| 83986 |
|
4,843 |
4,659 |
$11K |
| 59840 |
|
16 |
12 |
$5K |
| 58301 |
|
237 |
118 |
$4K |
| Q3014 |
Telehealth facility fee |
341 |
339 |
$4K |
| 90674 |
|
188 |
188 |
$3K |
| 81002 |
|
1,481 |
1,418 |
$2K |
| 90471 |
|
538 |
532 |
$2K |
| S5000 |
Prescription drug, generic |
960 |
779 |
$1K |
| S0191 |
Misoprostol, oral, 200 mcg |
481 |
471 |
$1K |
| 99201 |
|
40 |
40 |
$856.48 |
| J3490 |
Drugs unclassified injection |
274 |
257 |
$806.74 |
| 85018 |
|
301 |
285 |
$374.45 |
| 99395 |
|
295 |
294 |
$305.61 |
| G0444 |
Depression screen annual |
30 |
29 |
$242.40 |
| 86901 |
|
79 |
79 |
$189.38 |
| 83036 |
|
109 |
108 |
$42.70 |
| G8783 |
Bp scrn perf rec interval |
114 |
110 |
$0.00 |