| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J7307 |
Etonogestrel implant system |
884 |
808 |
$928K |
| 99212 |
|
12,085 |
11,029 |
$869K |
| J7298 |
Mirena, 52 mg |
550 |
446 |
$469K |
| J3490 |
Drugs unclassified injection |
8,431 |
7,306 |
$403K |
| S4993 |
Contraceptive pills for bc |
1,569 |
1,566 |
$235K |
| 58300 |
|
2,182 |
1,108 |
$203K |
| 90651 |
|
584 |
580 |
$153K |
| A4267 |
Male condom |
9,292 |
9,274 |
$152K |
| 11981 |
|
599 |
596 |
$129K |
| 99202 |
|
785 |
723 |
$105K |
| J7300 |
Intra copp contra (paragard) |
132 |
114 |
$91K |
| S0199 |
Med abortion inc all ex drug |
236 |
235 |
$83K |
| 11976 |
|
981 |
503 |
$56K |
| G9920 |
Scrning perf and negative |
1,939 |
1,929 |
$49K |
| 99213 |
|
498 |
496 |
$41K |
| 58301 |
|
1,089 |
561 |
$31K |
| 99000 |
|
2,294 |
2,291 |
$27K |
| 99211 |
|
450 |
400 |
$26K |
| 76830 |
|
296 |
296 |
$18K |
| 99203 |
|
67 |
67 |
$17K |
| 59840 |
|
112 |
68 |
$17K |
| 99201 |
|
129 |
129 |
$14K |
| 57454 |
|
246 |
123 |
$14K |
| S9445 |
Pt education noc individ |
757 |
757 |
$10K |
| Q0144 |
Azithromycin dihydrate, oral |
494 |
434 |
$8K |
| S0190 |
Mifepristone, oral, 200 mg |
143 |
143 |
$7K |
| 87806 |
|
164 |
164 |
$4K |
| G2012 |
Brief check in by md/qhp |
231 |
222 |
$2K |
| Q0111 |
Wet mounts/ w preparations |
254 |
253 |
$925.24 |
| 81025 |
|
305 |
287 |
$840.00 |
| 76817 |
|
14 |
14 |
$813.94 |
| 87491 |
|
30 |
30 |
$810.42 |
| 87591 |
|
30 |
30 |
$807.82 |
| 01966 |
|
14 |
14 |
$539.27 |
| 83986 |
|
156 |
155 |
$496.85 |
| S0191 |
Misoprostol, oral, 200 mcg |
170 |
170 |
$440.45 |
| 85018 |
|
69 |
66 |
$140.25 |
| 86592 |
|
12 |
12 |
$46.08 |