| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S4993 |
Contraceptive pills for bc |
6,731 |
6,433 |
$960K |
| J1050 |
Medroxyprogesterone acetate |
7,515 |
7,375 |
$510K |
| J7307 |
Etonogestrel implant system |
596 |
580 |
$438K |
| 99395 |
|
5,917 |
5,893 |
$394K |
| 99213 |
|
13,884 |
12,910 |
$380K |
| J7295 |
Eth estr and eton monthly |
120 |
113 |
$160K |
| J7303 |
Contraceptive vaginal ring |
100 |
100 |
$158K |
| 81025 |
|
23,166 |
22,070 |
$157K |
| 99214 |
|
4,242 |
4,103 |
$150K |
| 99385 |
|
1,663 |
1,646 |
$123K |
| A4267 |
Male condom |
44,194 |
39,330 |
$113K |
| 99204 |
|
1,680 |
1,622 |
$98K |
| 96372 |
|
8,477 |
8,136 |
$97K |
| G0433 |
Elisa hiv-1/hiv-2 screen |
6,578 |
6,499 |
$95K |
| 99000 |
|
6,852 |
6,635 |
$68K |
| 87210 |
|
13,561 |
12,901 |
$62K |
| 11982 |
|
540 |
538 |
$55K |
| 57454 |
|
628 |
622 |
$52K |
| 99211 |
|
3,376 |
3,285 |
$36K |
| 99396 |
|
495 |
493 |
$36K |
| 90651 |
|
125 |
123 |
$27K |
| 99212 |
|
1,446 |
1,370 |
$26K |
| 11981 |
|
295 |
288 |
$24K |
| A4269 |
Spermicide |
1,371 |
1,336 |
$19K |
| A9150 |
Misc/exper non-prescript dru |
1,300 |
1,263 |
$18K |
| 81002 |
|
6,280 |
6,003 |
$17K |
| J3490 |
Drugs unclassified injection |
491 |
406 |
$17K |
| J7304 |
Contraceptive hormone patch |
53 |
52 |
$14K |
| 99202 |
|
429 |
416 |
$13K |
| 87591 |
|
1,405 |
1,400 |
$7K |
| 87491 |
|
1,405 |
1,400 |
$7K |
| 11983 |
|
25 |
24 |
$4K |
| 90471 |
|
729 |
715 |
$4K |
| 58301 |
|
60 |
60 |
$4K |
| 99201 |
|
116 |
115 |
$2K |
| 87661 |
|
353 |
334 |
$2K |
| 58300 |
|
26 |
26 |
$2K |
| 99406 |
|
533 |
521 |
$1K |
| J0558 |
Peng benzathine/procaine inj |
89 |
58 |
$703.56 |
| 0012A |
|
18 |
18 |
$640.00 |
| 85018 |
|
191 |
167 |
$364.36 |
| 87510 |
|
102 |
99 |
$286.28 |
| 87389 |
|
64 |
63 |
$80.92 |
| 88142 |
|
120 |
120 |
$51.06 |
| J0696 |
Ceftriaxone sodium injection |
161 |
156 |
$14.97 |
| 86592 |
|
65 |
64 |
$7.18 |
| S5000 |
Prescription drug, generic |
1,623 |
1,565 |
$0.00 |
| 87660 |
|
28 |
28 |
$0.00 |