| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S4993 |
Contraceptive pills for bc |
212,108 |
114,467 |
$13.18M |
| J7304 |
Contraceptive hormone patch |
11,773 |
11,554 |
$2.28M |
| H1010 |
Nonmed family planning ed |
20,424 |
17,853 |
$1.96M |
| T5999 |
Supply, nos |
24,235 |
23,415 |
$1.79M |
| A4267 |
Male condom |
118,684 |
116,202 |
$1.50M |
| J7303 |
Contraceptive vaginal ring |
5,211 |
5,120 |
$341K |
| J7307 |
Etonogestrel implant system |
521 |
484 |
$196K |
| 99213 |
|
4,599 |
4,354 |
$191K |
| 99214 |
|
2,188 |
2,033 |
$129K |
| 99203 |
|
1,727 |
1,637 |
$114K |
| J1050 |
Medroxyprogesterone acetate |
2,208 |
2,095 |
$62K |
| 58300 |
|
1,295 |
1,235 |
$47K |
| 11981 |
|
497 |
470 |
$38K |
| J7297 |
Liletta, 52 mg |
504 |
481 |
$37K |
| J7300 |
Intra copp contra (paragard) |
157 |
151 |
$35K |
| 99204 |
|
314 |
298 |
$29K |
| 99212 |
|
688 |
639 |
$19K |
| 99000 |
|
4,240 |
4,047 |
$15K |
| J8499 |
Oral prescrip drug non chemo |
482 |
377 |
$10K |
| J7295 |
Eth estr and eton monthly |
3,181 |
3,081 |
$3K |
| 99202 |
|
75 |
66 |
$3K |
| 87210 |
|
412 |
373 |
$2K |
| 81025 |
|
265 |
245 |
$2K |
| 87806 |
|
30 |
30 |
$788.40 |
| J3490 |
Drugs unclassified injection |
45 |
44 |
$507.82 |