| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 87491 |
|
53,634 |
52,450 |
$2.43M |
| 87591 |
|
53,652 |
52,471 |
$2.31M |
| 59840 |
|
6,036 |
5,698 |
$2.20M |
| 99214 |
|
21,000 |
20,644 |
$1.70M |
| 99213 |
|
31,775 |
31,237 |
$1.63M |
| J3490 |
Drugs unclassified injection |
20,002 |
19,156 |
$1.18M |
| S4993 |
Contraceptive pills for bc |
8,325 |
8,266 |
$958K |
| 87806 |
|
33,827 |
33,533 |
$802K |
| 99212 |
|
17,276 |
16,970 |
$667K |
| 87661 |
|
20,357 |
20,052 |
$605K |
| J7307 |
Etonogestrel implant system |
654 |
636 |
$529K |
| 58300 |
|
2,624 |
1,815 |
$342K |
| S0199 |
Med abortion inc all ex drug |
581 |
579 |
$310K |
| 76817 |
|
7,500 |
6,110 |
$292K |
| 99152 |
|
5,599 |
4,932 |
$283K |
| 99203 |
|
1,658 |
1,658 |
$197K |
| A4267 |
Male condom |
14,409 |
14,224 |
$176K |
| 99211 |
|
4,362 |
4,289 |
$118K |
| 81025 |
|
37,441 |
36,503 |
$99K |
| 11981 |
|
650 |
642 |
$93K |
| J7300 |
Intra copp contra (paragard) |
110 |
109 |
$76K |
| 99202 |
|
1,160 |
1,158 |
$74K |
| 59841 |
|
118 |
117 |
$65K |
| J7297 |
Liletta, 52 mg |
107 |
107 |
$60K |
| 55250 |
|
378 |
189 |
$56K |
| 87529 |
|
944 |
939 |
$55K |
| 99201 |
|
1,071 |
1,071 |
$47K |
| S0190 |
Mifepristone, oral, 200 mg |
726 |
726 |
$41K |
| J1050 |
Medroxyprogesterone acetate |
430 |
430 |
$38K |
| 87210 |
|
10,778 |
10,629 |
$38K |
| 99000 |
|
10,776 |
10,502 |
$35K |
| 83986 |
|
10,706 |
10,552 |
$33K |
| Q3014 |
Telehealth facility fee |
1,749 |
1,730 |
$30K |
| J7298 |
Mirena, 52 mg |
32 |
32 |
$23K |
| S5199 |
Personal care item nos each |
2,221 |
2,191 |
$17K |
| J7296 |
Kyleena, 19.5 mg |
13 |
13 |
$16K |
| 85018 |
|
8,846 |
7,295 |
$8K |
| 99401 |
|
330 |
330 |
$6K |
| 86701 |
|
814 |
805 |
$6K |
| 57460 |
|
47 |
28 |
$6K |
| 76815 |
|
94 |
92 |
$5K |
| J7304 |
Contraceptive hormone patch |
13 |
13 |
$5K |
| 81002 |
|
2,195 |
2,158 |
$5K |
| 11976 |
|
43 |
43 |
$4K |
| 96372 |
|
140 |
140 |
$3K |
| 86901 |
|
1,166 |
1,138 |
$2K |
| 76998 |
|
43 |
41 |
$2K |
| S0191 |
Misoprostol, oral, 200 mcg |
788 |
779 |
$2K |
| 36415 |
|
432 |
397 |
$158.55 |
| S5000 |
Prescription drug, generic |
12 |
12 |
$27.95 |