| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J7307 |
Etonogestrel implant system |
679 |
677 |
$653K |
| 99214 |
|
2,550 |
2,462 |
$499K |
| 99203 |
|
1,485 |
1,439 |
$472K |
| S4993 |
Contraceptive pills for bc |
4,955 |
4,940 |
$450K |
| 99213 |
|
3,519 |
3,310 |
$449K |
| 99211 |
|
7,190 |
6,346 |
$448K |
| 99212 |
|
4,243 |
4,108 |
$410K |
| J3490 |
Drugs unclassified injection |
10,757 |
9,378 |
$403K |
| 99202 |
|
1,656 |
1,633 |
$309K |
| 99204 |
|
496 |
496 |
$196K |
| 11981 |
|
670 |
670 |
$170K |
| 87806 |
|
4,675 |
3,683 |
$117K |
| 58300 |
|
1,030 |
536 |
$107K |
| 99201 |
|
705 |
645 |
$85K |
| J7300 |
Intra copp contra (paragard) |
107 |
106 |
$73K |
| S0199 |
Med abortion inc all ex drug |
120 |
120 |
$60K |
| 81025 |
|
12,196 |
11,836 |
$52K |
| A4267 |
Male condom |
5,480 |
5,439 |
$38K |
| 11976 |
|
575 |
290 |
$36K |
| S9445 |
Pt education noc individ |
2,580 |
2,580 |
$33K |
| J7298 |
Mirena, 52 mg |
40 |
37 |
$29K |
| 99401 |
|
1,525 |
1,517 |
$29K |
| S5000 |
Prescription drug, generic |
3,297 |
3,149 |
$24K |
| J7303 |
Contraceptive vaginal ring |
245 |
244 |
$23K |
| J7304 |
Contraceptive hormone patch |
76 |
76 |
$19K |
| 58301 |
|
602 |
302 |
$18K |
| 83986 |
|
5,316 |
4,340 |
$14K |
| 99000 |
|
3,696 |
3,673 |
$13K |
| Q0111 |
Wet mounts/ w preparations |
3,133 |
3,084 |
$11K |
| 87591 |
|
378 |
327 |
$10K |
| 87491 |
|
369 |
325 |
$10K |
| 86703 |
|
682 |
532 |
$7K |
| 99402 |
|
204 |
204 |
$6K |
| 76817 |
|
92 |
90 |
$6K |
| 99403 |
|
114 |
114 |
$5K |
| S0190 |
Mifepristone, oral, 200 mg |
99 |
99 |
$5K |
| Q0144 |
Azithromycin dihydrate, oral |
974 |
956 |
$4K |
| 81002 |
|
1,241 |
1,216 |
$2K |
| 85018 |
|
317 |
314 |
$1K |
| 86592 |
|
355 |
354 |
$1K |
| 87389 |
|
58 |
58 |
$1K |
| 82120 |
|
197 |
195 |
$712.77 |
| 87210 |
|
199 |
197 |
$697.12 |
| J0696 |
Ceftriaxone sodium injection |
63 |
62 |
$339.90 |
| S0191 |
Misoprostol, oral, 200 mcg |
119 |
119 |
$291.00 |
| J1885 |
Ketorolac tromethamine inj |
13 |
13 |
$64.20 |