| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
|
6,486 |
6,338 |
$694K |
| S4993 |
Contraceptive pills for bc |
5,275 |
5,179 |
$526K |
| J3490 |
Drugs unclassified injection |
8,875 |
8,010 |
$396K |
| 99212 |
|
4,573 |
4,436 |
$353K |
| 99214 |
|
1,771 |
1,749 |
$305K |
| 87806 |
|
9,387 |
8,392 |
$251K |
| 99202 |
|
1,592 |
1,588 |
$240K |
| 99211 |
|
3,619 |
3,593 |
$189K |
| 99201 |
|
1,018 |
1,011 |
$116K |
| S0199 |
Med abortion inc all ex drug |
187 |
187 |
$116K |
| A4267 |
Male condom |
4,937 |
4,868 |
$53K |
| 99203 |
|
202 |
202 |
$46K |
| J7307 |
Etonogestrel implant system |
49 |
47 |
$45K |
| 87591 |
|
1,171 |
1,140 |
$29K |
| 86780 |
|
2,655 |
2,649 |
$29K |
| 87491 |
|
1,139 |
1,111 |
$29K |
| S5000 |
Prescription drug, generic |
2,637 |
2,505 |
$28K |
| S9445 |
Pt education noc individ |
2,225 |
2,225 |
$28K |
| 81025 |
|
7,513 |
7,391 |
$25K |
| J7303 |
Contraceptive vaginal ring |
25 |
25 |
$21K |
| 86703 |
|
1,698 |
1,497 |
$18K |
| 11981 |
|
70 |
69 |
$15K |
| S0190 |
Mifepristone, oral, 200 mg |
173 |
173 |
$13K |
| A4649 |
Surgical supplies |
957 |
820 |
$12K |
| 83986 |
|
3,678 |
3,033 |
$11K |
| 58300 |
|
100 |
51 |
$10K |
| Q0144 |
Azithromycin dihydrate, oral |
865 |
649 |
$5K |
| Q0111 |
Wet mounts/ w preparations |
1,307 |
1,284 |
$5K |
| 87624 |
|
122 |
85 |
$4K |
| 11976 |
|
57 |
29 |
$3K |
| 87210 |
|
854 |
788 |
$3K |
| 87801 |
|
62 |
61 |
$2K |
| 99000 |
|
548 |
537 |
$2K |
| 81002 |
|
739 |
721 |
$1K |
| 86803 |
|
62 |
62 |
$926.04 |
| 87808 |
|
71 |
71 |
$725.18 |
| 90674 |
|
14 |
14 |
$462.00 |
| 88142 |
|
37 |
37 |
$387.73 |
| 85018 |
|
90 |
88 |
$203.91 |
| S0191 |
Misoprostol, oral, 200 mcg |
203 |
199 |
$184.91 |
| 86592 |
|
45 |
45 |
$174.34 |