| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 76815 |
|
15,676 |
14,856 |
$829K |
| S4993 |
Contraceptive pills for bc |
7,755 |
5,744 |
$752K |
| J8499 |
Oral prescrip drug non chemo |
11,251 |
9,869 |
$262K |
| 59841 |
|
935 |
869 |
$170K |
| 76817 |
|
2,223 |
2,099 |
$109K |
| J3490 |
Drugs unclassified injection |
1,204 |
1,179 |
$106K |
| A4267 |
Male condom |
7,848 |
7,440 |
$93K |
| S0190 |
Mifepristone, oral, 200 mg |
1,103 |
1,055 |
$44K |
| 36416 |
|
8,870 |
8,324 |
$27K |
| 87591 |
|
679 |
659 |
$23K |
| 87491 |
|
677 |
657 |
$23K |
| 87806 |
|
709 |
681 |
$22K |
| 85018 |
|
10,200 |
9,477 |
$20K |
| 86901 |
|
6,705 |
6,286 |
$16K |
| 99152 |
|
479 |
461 |
$14K |
| 84702 |
|
872 |
830 |
$9K |
| 99203 |
|
100 |
97 |
$8K |
| 86780 |
|
518 |
503 |
$7K |
| 36415 |
|
2,884 |
2,679 |
$7K |
| 58300 |
|
83 |
83 |
$6K |
| 96372 |
|
504 |
445 |
$5K |
| 99213 |
|
218 |
206 |
$4K |
| 59200 |
|
13 |
13 |
$801.46 |
| S0191 |
Misoprostol, oral, 200 mcg |
1,293 |
1,228 |
$759.52 |
| 81025 |
|
77 |
77 |
$581.29 |
| J3010 |
Fentanyl citrate injection |
447 |
431 |
$260.08 |
| 99202 |
|
97 |
92 |
$186.75 |
| 86592 |
|
36 |
33 |
$152.79 |
| S0119 |
Ondansetron 4 mg |
1,823 |
1,734 |
$135.38 |
| J1885 |
Ketorolac tromethamine inj |
127 |
125 |
$69.73 |
| J2250 |
Inj midazolam hydrochloride |
480 |
462 |
$37.61 |
| J2405 |
Ondansetron hcl injection |
89 |
86 |
$5.76 |
| J7298 |
Mirena, 52 mg |
12 |
12 |
$0.00 |