| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S4993 |
Contraceptive pills for bc |
111,396 |
79,537 |
$10.81M |
| J7307 |
Etonogestrel implant system |
3,938 |
3,891 |
$4.13M |
| 99213 |
|
39,799 |
38,393 |
$2.28M |
| 99214 |
|
25,232 |
24,353 |
$2.13M |
| J1050 |
Medroxyprogesterone acetate |
21,839 |
21,380 |
$2.01M |
| J8499 |
Oral prescrip drug non chemo |
22,836 |
20,576 |
$1.50M |
| J7304 |
Contraceptive hormone patch |
4,060 |
3,841 |
$1.48M |
| J7303 |
Contraceptive vaginal ring |
4,628 |
4,268 |
$1.44M |
| 87806 |
|
49,598 |
48,393 |
$1.40M |
| 87591 |
|
40,538 |
36,998 |
$1.24M |
| 87491 |
|
40,532 |
36,989 |
$1.24M |
| 99202 |
|
19,785 |
19,321 |
$1.08M |
| A4267 |
Male condom |
82,554 |
80,585 |
$947K |
| J7300 |
Intra copp contra (paragard) |
696 |
683 |
$714K |
| J7297 |
Liletta, 52 mg |
767 |
759 |
$602K |
| J7298 |
Mirena, 52 mg |
458 |
451 |
$478K |
| J3490 |
Drugs unclassified injection |
5,365 |
5,156 |
$435K |
| 99203 |
|
4,674 |
4,603 |
$402K |
| 99204 |
|
3,042 |
2,992 |
$391K |
| 81025 |
|
47,610 |
45,740 |
$356K |
| 96372 |
|
25,926 |
25,172 |
$341K |
| 11981 |
|
3,051 |
3,013 |
$314K |
| 99212 |
|
7,105 |
6,938 |
$305K |
| 11982 |
|
2,567 |
2,524 |
$279K |
| 86780 |
|
20,573 |
19,953 |
$257K |
| 99395 |
|
2,452 |
2,391 |
$256K |
| 58300 |
|
3,456 |
3,374 |
$255K |
| 87661 |
|
6,117 |
5,861 |
$177K |
| 58301 |
|
1,999 |
1,956 |
$163K |
| 87210 |
|
28,371 |
27,169 |
$142K |
| J7296 |
Kyleena, 19.5 mg |
146 |
143 |
$113K |
| 36415 |
|
38,652 |
37,800 |
$113K |
| 87389 |
|
4,393 |
4,337 |
$92K |
| Q0091 |
Obtaining screen pap smear |
4,189 |
4,064 |
$82K |
| J7295 |
Eth estr and eton monthly |
290 |
251 |
$72K |
| 36416 |
|
22,082 |
21,546 |
$64K |
| 99385 |
|
419 |
412 |
$58K |
| 86592 |
|
13,619 |
13,354 |
$47K |
| 83986 |
|
11,020 |
10,599 |
$37K |
| 11983 |
|
193 |
191 |
$23K |
| 86803 |
|
1,432 |
1,405 |
$19K |
| 99201 |
|
612 |
599 |
$19K |
| 88142 |
|
1,089 |
1,061 |
$18K |
| 81002 |
|
6,050 |
5,813 |
$14K |
| 99215 |
Prolong outpt/office vis |
88 |
87 |
$12K |
| 87529 |
|
117 |
59 |
$4K |
| 99211 |
|
329 |
319 |
$4K |
| 87624 |
|
104 |
103 |
$3K |
| 99205 |
Prolong outpt/office vis |
16 |
16 |
$3K |
| 84403 |
|
79 |
79 |
$2K |
| 0004A |
|
52 |
49 |
$2K |
| 76815 |
|
19 |
19 |
$1K |
| 90471 |
|
68 |
68 |
$922.06 |
| J0696 |
Ceftriaxone sodium injection |
1,510 |
1,446 |
$695.20 |
| 87563 |
|
14 |
14 |
$485.85 |
| Q0144 |
Azithromycin dihydrate, oral |
30 |
28 |
$453.85 |
| 85018 |
|
152 |
150 |
$353.26 |
| 87255 |
|
28 |
26 |
$0.00 |
| S0191 |
Misoprostol, oral, 200 mcg |
13 |
13 |
$0.00 |
| S0190 |
Mifepristone, oral, 200 mg |
13 |
13 |
$0.00 |