| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
|
5,501 |
4,979 |
$731K |
| 99214 |
|
2,911 |
2,746 |
$617K |
| 99203 |
|
1,755 |
1,687 |
$552K |
| 99212 |
|
4,483 |
4,258 |
$439K |
| S4993 |
Contraceptive pills for bc |
3,190 |
3,181 |
$372K |
| J3490 |
Drugs unclassified injection |
10,893 |
9,239 |
$356K |
| 99202 |
|
1,636 |
1,605 |
$313K |
| 87806 |
|
7,409 |
5,613 |
$188K |
| 99211 |
|
2,705 |
2,637 |
$184K |
| 99204 |
|
350 |
350 |
$137K |
| J7307 |
Etonogestrel implant system |
79 |
79 |
$68K |
| 58300 |
|
676 |
331 |
$62K |
| 99401 |
|
3,233 |
3,153 |
$62K |
| A4267 |
Male condom |
7,186 |
7,097 |
$51K |
| 99201 |
|
360 |
355 |
$45K |
| S5000 |
Prescription drug, generic |
4,788 |
4,544 |
$30K |
| 81025 |
|
8,500 |
8,168 |
$27K |
| S9445 |
Pt education noc individ |
2,099 |
2,099 |
$27K |
| 58301 |
|
631 |
316 |
$21K |
| 90651 |
|
71 |
71 |
$20K |
| 83986 |
|
7,531 |
6,062 |
$20K |
| Q0111 |
Wet mounts/ w preparations |
5,151 |
4,960 |
$19K |
| J7303 |
Contraceptive vaginal ring |
225 |
224 |
$19K |
| 99000 |
|
4,485 |
4,440 |
$16K |
| 99402 |
|
488 |
485 |
$16K |
| 11981 |
|
67 |
67 |
$15K |
| 86703 |
|
941 |
718 |
$10K |
| 81002 |
|
2,269 |
2,197 |
$4K |
| 57454 |
|
53 |
27 |
$3K |
| Q0144 |
Azithromycin dihydrate, oral |
808 |
794 |
$3K |
| 76857 |
|
41 |
41 |
$2K |
| 11976 |
|
24 |
12 |
$1K |
| 87491 |
|
33 |
33 |
$782.66 |
| 87591 |
|
33 |
32 |
$773.79 |
| 86592 |
|
135 |
135 |
$447.59 |
| 82120 |
|
91 |
87 |
$328.10 |
| J0696 |
Ceftriaxone sodium injection |
57 |
39 |
$298.01 |
| 87210 |
|
90 |
86 |
$297.21 |
| S5001 |
Prescription drug,brand name |
15 |
15 |
$188.00 |