| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0199 |
Med abortion inc all ex drug |
1,710 |
1,301 |
$291K |
| J3490 |
Drugs unclassified injection |
6,025 |
4,744 |
$189K |
| J7307 |
Etonogestrel implant system |
411 |
336 |
$186K |
| 99212 |
|
2,436 |
2,215 |
$134K |
| 59840 |
|
1,441 |
672 |
$114K |
| 99202 |
|
1,183 |
1,052 |
$101K |
| J7298 |
Mirena, 52 mg |
174 |
144 |
$95K |
| 58300 |
|
912 |
407 |
$80K |
| 99213 |
|
2,627 |
2,414 |
$66K |
| S4993 |
Contraceptive pills for bc |
626 |
551 |
$59K |
| 11981 |
|
415 |
357 |
$58K |
| A4267 |
Male condom |
3,901 |
3,398 |
$52K |
| Q0144 |
Azithromycin dihydrate, oral |
2,526 |
1,982 |
$39K |
| S0191 |
Misoprostol, oral, 200 mcg |
1,091 |
883 |
$34K |
| 76817 |
|
1,304 |
1,196 |
$29K |
| 99203 |
|
144 |
144 |
$24K |
| S0190 |
Mifepristone, oral, 200 mg |
1,075 |
864 |
$17K |
| 87491 |
|
2,128 |
2,100 |
$16K |
| G9920 |
Scrning perf and negative |
648 |
642 |
$15K |
| 99201 |
|
357 |
349 |
$11K |
| 90651 |
|
42 |
41 |
$7K |
| J7296 |
Kyleena, 19.5 mg |
45 |
29 |
$7K |
| 99211 |
|
210 |
167 |
$6K |
| Q0111 |
Wet mounts/ w preparations |
1,068 |
987 |
$6K |
| S9445 |
Pt education noc individ |
293 |
293 |
$4K |
| 11976 |
|
131 |
63 |
$3K |
| 58301 |
|
186 |
87 |
$3K |
| 99000 |
|
217 |
214 |
$3K |
| G9919 |
Scrn nd pos nd prov of rec |
84 |
84 |
$3K |
| 81025 |
|
2,861 |
2,616 |
$2K |
| 76830 |
|
37 |
37 |
$1K |
| 87591 |
|
2,126 |
2,098 |
$715.77 |
| 76815 |
|
30 |
27 |
$566.55 |
| 01966 |
|
34 |
31 |
$453.94 |
| 85018 |
|
24 |
24 |
$396.00 |
| G2012 |
Brief check in by md/qhp |
47 |
44 |
$360.44 |
| 87806 |
|
399 |
395 |
$354.09 |
| 86592 |
|
702 |
696 |
$224.23 |
| J0696 |
Ceftriaxone sodium injection |
13 |
13 |
$102.98 |
| 81002 |
|
280 |
272 |
$36.80 |
| A4649 |
Surgical supplies |
12 |
12 |
$36.00 |
| 87210 |
|
19 |
18 |
$24.92 |
| 87661 |
|
31 |
31 |
$0.00 |
| 87481 |
|
44 |
44 |
$0.00 |
| 87799 |
|
31 |
31 |
$0.00 |