| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0199 |
Med abortion inc all ex drug |
6,585 |
6,443 |
$3.34M |
| J7307 |
Etonogestrel implant system |
2,255 |
2,192 |
$2.44M |
| J7298 |
Mirena, 52 mg |
783 |
768 |
$794K |
| 99212 |
|
17,010 |
16,145 |
$779K |
| 59840 |
|
3,783 |
1,864 |
$590K |
| J3490 |
Drugs unclassified injection |
12,839 |
11,618 |
$564K |
| 90651 |
|
2,062 |
2,049 |
$521K |
| 11981 |
|
2,145 |
2,123 |
$487K |
| S4993 |
Contraceptive pills for bc |
3,685 |
3,457 |
$486K |
| 58300 |
|
4,271 |
2,121 |
$398K |
| S0190 |
Mifepristone, oral, 200 mg |
6,189 |
6,124 |
$378K |
| J7300 |
Intra copp contra (paragard) |
235 |
232 |
$226K |
| 99202 |
|
2,910 |
2,906 |
$210K |
| 76817 |
|
2,756 |
2,589 |
$207K |
| 11976 |
|
2,832 |
1,427 |
$172K |
| G9920 |
Scrning perf and negative |
5,362 |
5,354 |
$149K |
| 99211 |
|
3,581 |
3,336 |
$110K |
| 76815 |
|
1,489 |
1,466 |
$86K |
| 99152 |
|
1,874 |
1,804 |
$84K |
| A4267 |
Male condom |
7,965 |
7,648 |
$81K |
| 99213 |
|
1,323 |
1,256 |
$68K |
| J7304 |
Contraceptive hormone patch |
27 |
27 |
$66K |
| 58301 |
|
2,054 |
1,044 |
$64K |
| 76830 |
|
816 |
811 |
$50K |
| Q0144 |
Azithromycin dihydrate, oral |
5,103 |
4,797 |
$50K |
| 87491 |
|
1,046 |
1,043 |
$39K |
| 99201 |
|
493 |
489 |
$24K |
| S0191 |
Misoprostol, oral, 200 mcg |
6,214 |
6,146 |
$20K |
| G9919 |
Scrn nd pos nd prov of rec |
573 |
572 |
$16K |
| 57454 |
|
236 |
119 |
$13K |
| 87591 |
|
1,045 |
1,042 |
$13K |
| 01966 |
|
217 |
217 |
$10K |
| 87806 |
|
574 |
567 |
$10K |
| 59841 |
|
58 |
30 |
$10K |
| G2012 |
Brief check in by md/qhp |
754 |
734 |
$9K |
| 11982 |
|
126 |
71 |
$7K |
| 81025 |
|
1,455 |
1,406 |
$5K |
| S9445 |
Pt education noc individ |
318 |
318 |
$4K |
| 76856 |
|
65 |
65 |
$4K |
| 87799 |
|
112 |
112 |
$3K |
| 87481 |
|
126 |
125 |
$2K |
| 87661 |
|
101 |
101 |
$2K |
| Q0111 |
Wet mounts/ w preparations |
473 |
458 |
$2K |
| 99000 |
|
410 |
408 |
$2K |
| 87563 |
|
30 |
30 |
$2K |
| 83986 |
|
451 |
446 |
$1K |
| T1014 |
Telehealth transmit, per min |
537 |
534 |
$768.77 |
| J0696 |
Ceftriaxone sodium injection |
134 |
134 |
$672.26 |
| 81002 |
|
36 |
36 |
$76.38 |
| 85018 |
|
24 |
24 |
$49.47 |
| 87210 |
|
12 |
12 |
$42.72 |
| 86592 |
|
16 |
16 |
$0.00 |