| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
|
13,524 |
12,911 |
$1.47M |
| 99214 |
|
8,668 |
8,059 |
$1.40M |
| S4993 |
Contraceptive pills for bc |
5,602 |
5,498 |
$639K |
| 87806 |
|
21,283 |
17,127 |
$540K |
| 99212 |
|
5,716 |
5,132 |
$433K |
| 99203 |
|
1,247 |
1,204 |
$341K |
| J3490 |
Drugs unclassified injection |
6,469 |
5,595 |
$313K |
| 99202 |
|
1,061 |
978 |
$174K |
| 99201 |
|
1,464 |
1,307 |
$150K |
| 99211 |
|
2,147 |
2,113 |
$111K |
| J7307 |
Etonogestrel implant system |
118 |
118 |
$93K |
| S0199 |
Med abortion inc all ex drug |
163 |
162 |
$87K |
| A4267 |
Male condom |
4,326 |
4,281 |
$41K |
| 81025 |
|
13,022 |
12,727 |
$41K |
| 99000 |
|
8,543 |
8,340 |
$31K |
| 58300 |
|
264 |
140 |
$25K |
| S9445 |
Pt education noc individ |
1,891 |
1,891 |
$24K |
| S5000 |
Prescription drug, generic |
3,390 |
3,227 |
$22K |
| 11981 |
|
106 |
106 |
$21K |
| 83986 |
|
4,999 |
4,570 |
$14K |
| S0190 |
Mifepristone, oral, 200 mg |
182 |
179 |
$12K |
| 87210 |
|
3,584 |
3,517 |
$12K |
| S5199 |
Personal care item nos each |
1,613 |
1,596 |
$8K |
| 86701 |
|
1,138 |
850 |
$7K |
| 76817 |
|
227 |
222 |
$6K |
| J7303 |
Contraceptive vaginal ring |
40 |
40 |
$5K |
| 57454 |
|
90 |
46 |
$5K |
| J7304 |
Contraceptive hormone patch |
13 |
13 |
$5K |
| 11976 |
|
40 |
40 |
$4K |
| Q0144 |
Azithromycin dihydrate, oral |
663 |
442 |
$4K |
| 58301 |
|
95 |
50 |
$2K |
| 81002 |
|
1,181 |
1,146 |
$2K |
| 99401 |
|
80 |
80 |
$2K |
| 11982 |
|
13 |
13 |
$1K |
| J1050 |
Medroxyprogesterone acetate |
12 |
12 |
$976.87 |
| S0191 |
Misoprostol, oral, 200 mcg |
220 |
205 |
$710.78 |
| 85018 |
|
181 |
178 |
$95.82 |
| J0696 |
Ceftriaxone sodium injection |
13 |
13 |
$64.90 |
| 36415 |
|
81 |
71 |
$63.00 |