| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J3490 |
Drugs unclassified injection |
16,486 |
14,394 |
$872K |
| 99213 |
|
8,600 |
8,147 |
$780K |
| S4993 |
Contraceptive pills for bc |
6,888 |
6,612 |
$766K |
| J7307 |
Etonogestrel implant system |
633 |
631 |
$670K |
| 99214 |
|
3,884 |
3,747 |
$529K |
| 99212 |
|
7,413 |
7,158 |
$482K |
| 99202 |
|
3,579 |
3,478 |
$449K |
| 87806 |
|
16,499 |
14,131 |
$405K |
| S0199 |
Med abortion inc all ex drug |
698 |
698 |
$353K |
| 99203 |
|
1,589 |
1,570 |
$332K |
| 99211 |
|
7,008 |
6,572 |
$326K |
| 99204 |
|
1,170 |
1,167 |
$265K |
| A4267 |
Male condom |
9,944 |
9,833 |
$236K |
| 90651 |
|
1,012 |
1,008 |
$218K |
| 11981 |
|
638 |
636 |
$174K |
| 58300 |
|
1,176 |
637 |
$149K |
| 99201 |
|
1,601 |
1,554 |
$143K |
| J7298 |
Mirena, 52 mg |
164 |
163 |
$138K |
| J7304 |
Contraceptive hormone patch |
186 |
185 |
$127K |
| 81025 |
|
12,259 |
11,970 |
$65K |
| 11976 |
|
841 |
462 |
$55K |
| S0190 |
Mifepristone, oral, 200 mg |
676 |
675 |
$40K |
| S5199 |
Personal care item nos each |
8,089 |
8,037 |
$35K |
| S9445 |
Pt education noc individ |
1,982 |
1,982 |
$25K |
| J7303 |
Contraceptive vaginal ring |
74 |
70 |
$22K |
| 99000 |
|
7,295 |
7,199 |
$22K |
| 83986 |
|
5,402 |
4,593 |
$15K |
| S5000 |
Prescription drug, generic |
2,280 |
2,052 |
$14K |
| 58301 |
|
338 |
191 |
$14K |
| Q0111 |
Wet mounts/ w preparations |
2,675 |
2,619 |
$10K |
| 76817 |
|
161 |
160 |
$8K |
| 82120 |
|
2,085 |
1,990 |
$8K |
| 76815 |
|
65 |
65 |
$4K |
| 87210 |
|
1,067 |
1,057 |
$4K |
| Q0144 |
Azithromycin dihydrate, oral |
493 |
401 |
$3K |
| 81002 |
|
980 |
958 |
$2K |
| S0191 |
Misoprostol, oral, 200 mcg |
532 |
522 |
$2K |
| 99401 |
|
80 |
77 |
$2K |
| J0696 |
Ceftriaxone sodium injection |
44 |
44 |
$217.29 |
| 87491 |
|
469 |
467 |
$186.72 |
| 85018 |
|
94 |
93 |
$169.42 |
| 87591 |
|
469 |
467 |
$0.00 |