| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
|
6,990 |
6,646 |
$910K |
| 99213 |
|
6,607 |
6,257 |
$582K |
| 87806 |
|
17,282 |
15,179 |
$450K |
| J3490 |
Drugs unclassified injection |
15,128 |
13,085 |
$449K |
| S4993 |
Contraceptive pills for bc |
3,280 |
3,214 |
$413K |
| 99203 |
|
1,833 |
1,783 |
$388K |
| 99202 |
|
2,882 |
2,805 |
$368K |
| 99204 |
|
1,280 |
1,276 |
$308K |
| 99212 |
|
4,581 |
4,443 |
$281K |
| S0199 |
Med abortion inc all ex drug |
593 |
591 |
$279K |
| 99211 |
|
4,728 |
4,434 |
$192K |
| 90651 |
|
546 |
546 |
$120K |
| J7307 |
Etonogestrel implant system |
118 |
118 |
$98K |
| 58300 |
|
874 |
446 |
$82K |
| A4267 |
Male condom |
5,443 |
5,412 |
$47K |
| 99000 |
|
11,899 |
11,669 |
$46K |
| S0190 |
Mifepristone, oral, 200 mg |
604 |
601 |
$41K |
| 99201 |
|
417 |
414 |
$36K |
| 81025 |
|
11,968 |
11,613 |
$35K |
| 11981 |
|
142 |
142 |
$31K |
| J7298 |
Mirena, 52 mg |
44 |
44 |
$30K |
| S5000 |
Prescription drug, generic |
4,834 |
4,197 |
$26K |
| S9445 |
Pt education noc individ |
1,603 |
1,603 |
$20K |
| 83986 |
|
6,128 |
5,379 |
$19K |
| J7303 |
Contraceptive vaginal ring |
96 |
96 |
$14K |
| 76817 |
|
146 |
135 |
$13K |
| 82120 |
|
3,057 |
2,946 |
$13K |
| 58301 |
|
382 |
197 |
$11K |
| Q0111 |
Wet mounts/ w preparations |
2,503 |
2,430 |
$10K |
| 11976 |
|
155 |
79 |
$9K |
| 99402 |
|
281 |
280 |
$9K |
| 87210 |
|
1,896 |
1,835 |
$7K |
| S5199 |
Personal care item nos each |
4,970 |
4,933 |
$6K |
| Q0144 |
Azithromycin dihydrate, oral |
595 |
532 |
$4K |
| 99401 |
|
189 |
189 |
$4K |
| 81002 |
|
1,393 |
1,350 |
$3K |
| S0191 |
Misoprostol, oral, 200 mcg |
543 |
535 |
$2K |
| 76815 |
|
12 |
12 |
$790.92 |
| 85018 |
|
53 |
52 |
$105.78 |