| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S4993 |
Contraceptive pills for bc |
42,470 |
30,557 |
$3.43M |
| H1010 |
Nonmed family planning ed |
26,379 |
24,234 |
$2.49M |
| J1050 |
Medroxyprogesterone acetate |
6,687 |
6,521 |
$548K |
| A4267 |
Male condom |
26,752 |
25,281 |
$498K |
| 99395 |
|
7,019 |
6,839 |
$420K |
| J7307 |
Etonogestrel implant system |
357 |
348 |
$293K |
| A4268 |
Female condom |
26,408 |
24,954 |
$262K |
| 99213 |
|
6,300 |
5,875 |
$233K |
| 87661 |
|
7,061 |
6,632 |
$233K |
| J7304 |
Contraceptive hormone patch |
590 |
555 |
$222K |
| T5999 |
Supply, nos |
2,306 |
2,098 |
$161K |
| 90651 |
|
756 |
729 |
$160K |
| 99214 |
|
2,656 |
2,514 |
$150K |
| J7303 |
Contraceptive vaginal ring |
707 |
693 |
$121K |
| 87591 |
|
11,912 |
11,145 |
$114K |
| 87491 |
|
12,517 |
11,757 |
$114K |
| 99212 |
|
4,347 |
4,123 |
$109K |
| 99202 |
|
1,959 |
1,891 |
$79K |
| 99385 |
|
1,093 |
1,043 |
$63K |
| 86703 |
|
4,073 |
3,862 |
$53K |
| 99203 |
|
768 |
752 |
$50K |
| 99000 |
|
13,225 |
12,463 |
$48K |
| 81025 |
|
5,160 |
4,874 |
$43K |
| 99204 |
|
305 |
275 |
$33K |
| J8499 |
Oral prescrip drug non chemo |
5,616 |
4,438 |
$28K |
| 86780 |
|
3,640 |
3,411 |
$28K |
| 87210 |
|
4,808 |
4,474 |
$25K |
| S9445 |
Pt education noc individ |
1,046 |
999 |
$24K |
| J7295 |
Eth estr and eton monthly |
619 |
595 |
$21K |
| 96372 |
|
7,853 |
7,625 |
$21K |
| 99201 |
|
579 |
555 |
$13K |
| Q0144 |
Azithromycin dihydrate, oral |
759 |
721 |
$10K |
| 81002 |
|
2,375 |
2,236 |
$8K |
| 58300 |
|
170 |
166 |
$7K |
| 99401 |
|
220 |
125 |
$6K |
| 99394 |
|
105 |
103 |
$6K |
| 11981 |
|
67 |
67 |
$5K |
| 99396 |
|
147 |
146 |
$5K |
| 11982 |
|
24 |
24 |
$2K |
| 99211 |
|
125 |
122 |
$2K |
| J3490 |
Drugs unclassified injection |
37 |
36 |
$936.00 |
| 58301 |
|
24 |
24 |
$747.36 |
| 99384 |
|
13 |
12 |
$683.52 |
| 86803 |
|
31 |
29 |
$385.29 |
| 84443 |
|
12 |
12 |
$249.00 |
| 88142 |
|
3,849 |
3,712 |
$63.03 |
| J0696 |
Ceftriaxone sodium injection |
13 |
13 |
$8.40 |
| 87624 |
|
621 |
574 |
$0.00 |
| 36415 |
|
1,330 |
1,275 |
$0.00 |
| 88305 |
|
14 |
14 |
$0.00 |
| S0197 |
Prenatal vitamins 30 day |
1,761 |
1,636 |
$0.00 |