| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
|
4,114 |
3,882 |
$818K |
| 99213 |
|
5,275 |
4,761 |
$670K |
| 99211 |
|
9,875 |
8,577 |
$608K |
| 99212 |
|
6,551 |
6,320 |
$596K |
| S4993 |
Contraceptive pills for bc |
6,091 |
6,065 |
$562K |
| 99203 |
|
1,742 |
1,664 |
$544K |
| J3490 |
Drugs unclassified injection |
14,936 |
12,618 |
$524K |
| J7307 |
Etonogestrel implant system |
362 |
353 |
$326K |
| 99202 |
|
1,604 |
1,598 |
$310K |
| 99201 |
|
2,084 |
1,836 |
$253K |
| 87806 |
|
6,305 |
4,856 |
$156K |
| 99204 |
|
400 |
387 |
$153K |
| 11981 |
|
328 |
328 |
$76K |
| A4267 |
Male condom |
9,751 |
9,600 |
$59K |
| 58300 |
|
587 |
293 |
$52K |
| 81025 |
|
14,443 |
13,892 |
$45K |
| J7303 |
Contraceptive vaginal ring |
459 |
458 |
$39K |
| J7304 |
Contraceptive hormone patch |
140 |
140 |
$36K |
| S5000 |
Prescription drug, generic |
5,413 |
4,921 |
$35K |
| S9445 |
Pt education noc individ |
2,425 |
2,425 |
$31K |
| 99401 |
|
1,196 |
1,186 |
$23K |
| 11976 |
|
348 |
181 |
$23K |
| 83986 |
|
7,132 |
5,937 |
$19K |
| J7300 |
Intra copp contra (paragard) |
28 |
28 |
$19K |
| Q0111 |
Wet mounts/ w preparations |
4,474 |
4,358 |
$16K |
| 99000 |
|
3,245 |
3,219 |
$11K |
| 86703 |
|
1,026 |
747 |
$10K |
| Q0144 |
Azithromycin dihydrate, oral |
1,412 |
1,373 |
$5K |
| 81002 |
|
2,017 |
1,970 |
$4K |
| 90651 |
|
13 |
13 |
$4K |
| 87591 |
|
145 |
138 |
$3K |
| 87491 |
|
144 |
137 |
$3K |
| 58301 |
|
82 |
41 |
$2K |
| 57454 |
|
30 |
15 |
$2K |
| 99402 |
|
45 |
45 |
$1K |
| J0696 |
Ceftriaxone sodium injection |
203 |
178 |
$1K |
| 82120 |
|
318 |
311 |
$1K |
| 87210 |
|
323 |
315 |
$1K |
| 86592 |
|
178 |
176 |
$522.46 |
| 87389 |
|
15 |
14 |
$255.55 |