| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 59840 |
|
26,310 |
26,000 |
$18.19M |
| 99213 |
|
68,541 |
59,890 |
$9.41M |
| 99212 |
|
37,885 |
35,816 |
$6.09M |
| 76815 |
|
45,766 |
42,444 |
$4.87M |
| J7307 |
Etonogestrel implant system |
9,137 |
9,059 |
$4.40M |
| 99202 |
|
25,187 |
23,834 |
$3.78M |
| 99203 |
|
19,700 |
19,579 |
$2.95M |
| 76817 |
|
27,199 |
24,940 |
$2.87M |
| 11981 |
|
7,732 |
7,517 |
$2.00M |
| 11982 |
|
6,617 |
6,504 |
$2.00M |
| J7300 |
Intra copp contra (paragard) |
4,600 |
4,551 |
$1.98M |
| S0190 |
Mifepristone, oral, 200 mg |
27,640 |
27,429 |
$1.79M |
| 99395 |
|
11,624 |
11,074 |
$1.71M |
| 58300 |
|
11,478 |
11,168 |
$1.64M |
| 59841 |
|
2,003 |
1,982 |
$1.60M |
| 99214 |
|
9,609 |
9,325 |
$1.38M |
| J7297 |
Liletta, 52 mg |
3,261 |
3,221 |
$969K |
| 58301 |
|
6,313 |
6,145 |
$948K |
| 59200 |
|
1,543 |
1,482 |
$920K |
| 86703 |
|
56,563 |
56,104 |
$748K |
| 36416 |
|
30,307 |
30,050 |
$597K |
| 88304 |
|
11,321 |
11,243 |
$503K |
| J1050 |
Medroxyprogesterone acetate |
25,898 |
25,410 |
$478K |
| 90651 |
|
2,674 |
2,657 |
$468K |
| 96372 |
|
35,280 |
34,493 |
$436K |
| A4649 |
Surgical supplies |
945 |
880 |
$435K |
| 11983 |
|
1,098 |
1,093 |
$392K |
| 76830 |
|
3,461 |
3,311 |
$390K |
| 57454 |
|
771 |
765 |
$387K |
| 99385 |
|
2,538 |
2,532 |
$375K |
| 99204 |
|
2,422 |
2,414 |
$358K |
| J7301 |
Skyla, 13.5 mg |
908 |
901 |
$316K |
| 76857 |
|
2,341 |
2,293 |
$309K |
| 99396 |
|
1,980 |
1,969 |
$297K |
| 86901 |
|
10,057 |
9,969 |
$286K |
| J7296 |
Kyleena, 19.5 mg |
636 |
627 |
$240K |
| 99201 |
|
1,504 |
1,429 |
$226K |
| 81025 |
|
58,584 |
57,222 |
$179K |
| 36415 |
|
34,680 |
32,512 |
$131K |
| 99051 |
|
11,136 |
10,816 |
$125K |
| 99401 |
|
2,922 |
2,892 |
$119K |
| 87591 |
|
45,718 |
45,236 |
$111K |
| J7298 |
Mirena, 52 mg |
385 |
384 |
$97K |
| 99386 |
|
653 |
650 |
$92K |
| 87491 |
|
45,799 |
45,318 |
$72K |
| S0191 |
Misoprostol, oral, 200 mcg |
27,715 |
27,384 |
$70K |
| 87661 |
|
10,501 |
10,423 |
$70K |
| 76998 |
|
477 |
476 |
$67K |
| 99441 |
|
422 |
401 |
$57K |
| 99442 |
|
336 |
328 |
$45K |
| 99211 |
|
2,317 |
2,252 |
$41K |
| H0049 |
Alcohol/drug screening |
1,807 |
1,782 |
$29K |
| 87806 |
|
2,603 |
2,568 |
$22K |
| 64435 |
|
1,012 |
1,003 |
$22K |
| 99215 |
Prolong outpt/office vis |
113 |
112 |
$17K |
| 87624 |
|
4,571 |
4,569 |
$16K |
| 99406 |
|
369 |
366 |
$16K |
| S4993 |
Contraceptive pills for bc |
4,379 |
4,324 |
$13K |
| J2790 |
Rho d immune globulin inj |
116 |
116 |
$10K |
| 88142 |
|
569 |
569 |
$10K |
| 59812 |
|
12 |
12 |
$9K |
| 99394 |
|
42 |
42 |
$8K |
| 87210 |
|
18,600 |
18,182 |
$8K |
| 90471 |
|
2,054 |
2,042 |
$7K |
| 85018 |
|
13,467 |
13,249 |
$6K |
| 99443 |
|
41 |
41 |
$6K |
| S0119 |
Ondansetron 4 mg |
9,790 |
9,603 |
$5K |
| J8499 |
Oral prescrip drug non chemo |
7,926 |
6,342 |
$4K |
| 85013 |
|
4,017 |
3,950 |
$4K |
| 99000 |
|
287 |
283 |
$4K |
| J2788 |
Rho d immune globulin 50 mcg |
151 |
151 |
$3K |
| 88175 |
|
3,223 |
3,219 |
$3K |
| 81002 |
|
5,350 |
5,172 |
$3K |
| 96160 |
|
147 |
141 |
$3K |
| 99205 |
Prolong outpt/office vis |
12 |
12 |
$2K |
| 90385 |
|
780 |
777 |
$2K |
| J1885 |
Ketorolac tromethamine inj |
2,401 |
2,348 |
$1K |
| 88305 |
|
329 |
328 |
$1K |
| 86803 |
|
6,087 |
6,064 |
$1K |
| 99152 |
|
1,248 |
1,241 |
$1K |
| J3010 |
Fentanyl citrate injection |
4,642 |
4,587 |
$1K |
| 88300 |
|
8,099 |
8,075 |
$1K |
| 88174 |
|
47 |
47 |
$887.87 |
| 87798 |
|
139 |
137 |
$817.80 |
| 86696 |
|
643 |
640 |
$641.90 |
| J0696 |
Ceftriaxone sodium injection |
750 |
744 |
$637.29 |
| 86780 |
|
8,799 |
8,769 |
$629.93 |
| 96127 |
|
1,063 |
1,050 |
$617.55 |
| 90674 |
|
32 |
32 |
$507.81 |
| 87660 |
|
795 |
788 |
$489.13 |
| J2405 |
Ondansetron hcl injection |
3,306 |
3,266 |
$479.55 |
| 87510 |
|
806 |
799 |
$455.11 |
| 86592 |
|
988 |
975 |
$420.28 |
| 87480 |
|
808 |
801 |
$416.51 |
| 81005 |
|
1,838 |
1,815 |
$389.86 |
| J2250 |
Inj midazolam hydrochloride |
4,463 |
4,425 |
$389.28 |
| 83986 |
|
6,747 |
6,633 |
$364.70 |
| 87529 |
|
473 |
473 |
$356.21 |
| 87563 |
|
213 |
209 |
$339.95 |
| 84702 |
|
3,608 |
2,533 |
$270.02 |
| T1013 |
Sign lang/oral interpreter |
14 |
12 |
$187.00 |
| 87389 |
|
540 |
536 |
$163.60 |
| 86695 |
|
268 |
267 |
$124.00 |
| J2704 |
Inj, propofol, 10 mg |
880 |
828 |
$115.04 |
| G8510 |
Scr dep neg, no plan reqd |
2,038 |
2,012 |
$100.57 |
| 99072 |
|
3,994 |
3,608 |
$98.00 |
| 81003 |
|
575 |
565 |
$86.11 |
| A4550 |
Surgical trays |
1,191 |
1,182 |
$82.50 |
| 90472 |
|
251 |
249 |
$55.00 |
| 86706 |
|
137 |
137 |
$38.38 |
| 99070 |
|
243 |
241 |
$15.75 |
| 84520 |
|
77 |
77 |
$4.12 |
| 85025 |
|
39 |
39 |
$0.00 |
| 80048 |
|
17 |
17 |
$0.00 |
| 87521 |
Neg quan hep c or qual rna |
14 |
14 |
$0.00 |
| 99080 |
|
1,561 |
483 |
$0.00 |
| S5000 |
Prescription drug, generic |
66 |
64 |
$0.00 |
| Q0144 |
Azithromycin dihydrate, oral |
24 |
24 |
$0.00 |
| 84132 |
|
885 |
881 |
$-72.32 |
| 86704 |
|
217 |
217 |
$-72.50 |
| 83001 |
|
24 |
24 |
$-72.68 |
| 84403 |
|
1,656 |
1,648 |
$-102.52 |
| 87086 |
|
2,705 |
2,670 |
$-139.46 |
| 86593 |
|
592 |
590 |
$-163.56 |
| 84443 |
|
448 |
448 |
$-236.93 |
| 84146 |
|
278 |
278 |
$-257.89 |
| 82565 |
|
1,283 |
1,279 |
$-271.26 |
| 87340 |
|
908 |
907 |
$-287.41 |
| 82670 |
|
918 |
908 |
$-632.92 |