| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J7307 |
Etonogestrel implant system |
963 |
961 |
$851K |
| J3490 |
Drugs unclassified injection |
19,795 |
16,667 |
$823K |
| S0199 |
Med abortion inc all ex drug |
1,179 |
1,176 |
$720K |
| S4993 |
Contraceptive pills for bc |
5,146 |
5,124 |
$628K |
| 99213 |
|
5,151 |
4,988 |
$500K |
| 99211 |
|
13,540 |
13,082 |
$467K |
| 99214 |
|
2,761 |
2,721 |
$397K |
| 99202 |
|
2,480 |
2,478 |
$303K |
| 99212 |
|
4,137 |
4,061 |
$302K |
| 87806 |
|
7,907 |
7,166 |
$203K |
| 11981 |
|
1,040 |
1,035 |
$188K |
| 99201 |
|
2,245 |
2,233 |
$187K |
| A4267 |
Male condom |
13,218 |
13,158 |
$176K |
| 99203 |
|
912 |
912 |
$151K |
| 99204 |
|
496 |
495 |
$97K |
| 11976 |
|
1,113 |
603 |
$85K |
| S0190 |
Mifepristone, oral, 200 mg |
1,106 |
1,103 |
$69K |
| J7304 |
Contraceptive hormone patch |
96 |
96 |
$66K |
| 58300 |
|
725 |
373 |
$62K |
| J7303 |
Contraceptive vaginal ring |
125 |
125 |
$59K |
| J7298 |
Mirena, 52 mg |
66 |
66 |
$48K |
| 76815 |
|
681 |
657 |
$45K |
| 81025 |
|
8,246 |
8,138 |
$28K |
| 87661 |
|
917 |
914 |
$28K |
| 99000 |
|
6,182 |
6,067 |
$24K |
| S9445 |
Pt education noc individ |
1,801 |
1,801 |
$23K |
| T1999 |
Noc retail items andsupplies |
5,079 |
3,387 |
$20K |
| J7300 |
Intra copp contra (paragard) |
12 |
12 |
$13K |
| 99402 |
|
383 |
382 |
$12K |
| Q0111 |
Wet mounts/ w preparations |
2,978 |
2,928 |
$12K |
| 83986 |
|
3,775 |
3,416 |
$12K |
| 99401 |
|
592 |
589 |
$11K |
| 58301 |
|
303 |
155 |
$11K |
| 11982 |
|
114 |
59 |
$10K |
| Q0144 |
Azithromycin dihydrate, oral |
1,426 |
1,360 |
$8K |
| S5000 |
Prescription drug, generic |
944 |
859 |
$7K |
| 99403 |
|
140 |
140 |
$6K |
| S0191 |
Misoprostol, oral, 200 mcg |
1,281 |
1,269 |
$4K |
| G2012 |
Brief check in by md/qhp |
221 |
219 |
$3K |
| 99395 |
|
24 |
24 |
$3K |
| J0696 |
Ceftriaxone sodium injection |
505 |
489 |
$2K |
| 85018 |
|
716 |
670 |
$2K |
| Q3014 |
Telehealth facility fee |
61 |
61 |
$1K |
| 87591 |
|
25 |
25 |
$709.03 |
| 81002 |
|
310 |
309 |
$560.61 |
| 87491 |
|
19 |
19 |
$555.46 |
| 86901 |
|
55 |
55 |
$134.00 |
| T1014 |
Telehealth transmit, per min |
53 |
53 |
$72.70 |