| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J3490 |
Drugs unclassified injection |
9,800 |
7,765 |
$425K |
| S4993 |
Contraceptive pills for bc |
2,547 |
2,526 |
$334K |
| 99211 |
|
6,679 |
6,294 |
$285K |
| 99213 |
|
3,197 |
3,048 |
$268K |
| 99212 |
|
3,311 |
3,262 |
$232K |
| 99202 |
|
1,591 |
1,581 |
$196K |
| J7307 |
Etonogestrel implant system |
172 |
170 |
$190K |
| 99203 |
|
716 |
715 |
$146K |
| 87806 |
|
5,927 |
5,216 |
$143K |
| 99201 |
|
1,538 |
1,529 |
$143K |
| S0199 |
Med abortion inc all ex drug |
251 |
251 |
$126K |
| 99214 |
|
982 |
959 |
$126K |
| A4267 |
Male condom |
5,349 |
5,302 |
$81K |
| 11981 |
|
132 |
130 |
$34K |
| T1999 |
Noc retail items andsupplies |
1,648 |
1,199 |
$25K |
| 87661 |
|
699 |
698 |
$21K |
| 99000 |
|
4,871 |
4,797 |
$20K |
| 76815 |
|
197 |
186 |
$12K |
| S0190 |
Mifepristone, oral, 200 mg |
211 |
210 |
$12K |
| 81025 |
|
3,673 |
3,642 |
$11K |
| S9445 |
Pt education noc individ |
617 |
617 |
$8K |
| Q0111 |
Wet mounts/ w preparations |
1,670 |
1,639 |
$6K |
| 83986 |
|
1,803 |
1,642 |
$5K |
| S5000 |
Prescription drug, generic |
523 |
498 |
$4K |
| 99204 |
|
16 |
16 |
$4K |
| 11976 |
|
61 |
32 |
$3K |
| 99401 |
|
135 |
132 |
$3K |
| J7303 |
Contraceptive vaginal ring |
12 |
12 |
$2K |
| 87591 |
|
39 |
39 |
$1K |
| S0191 |
Misoprostol, oral, 200 mcg |
215 |
212 |
$613.64 |
| 87491 |
|
12 |
12 |
$305.47 |
| 81002 |
|
40 |
39 |
$78.26 |
| Q0144 |
Azithromycin dihydrate, oral |
15 |
14 |
$59.07 |