| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0199 |
Med abortion inc all ex drug |
5,411 |
5,264 |
$1.95M |
| 87491 |
|
37,692 |
37,172 |
$1.22M |
| 87591 |
|
37,646 |
37,145 |
$1.14M |
| 87806 |
|
38,563 |
37,064 |
$677K |
| 99212 |
|
27,224 |
26,163 |
$611K |
| 59840 |
|
2,950 |
1,611 |
$501K |
| J7307 |
Etonogestrel implant system |
581 |
581 |
$346K |
| 58300 |
|
3,473 |
1,818 |
$336K |
| 76817 |
|
3,691 |
3,484 |
$305K |
| A4267 |
Male condom |
14,501 |
14,414 |
$276K |
| 87661 |
|
14,562 |
14,442 |
$261K |
| J3490 |
Drugs unclassified injection |
11,432 |
10,778 |
$253K |
| 87799 |
|
9,913 |
9,872 |
$223K |
| 87481 |
|
9,924 |
9,882 |
$203K |
| 11981 |
|
1,153 |
1,150 |
$198K |
| 90651 |
|
1,072 |
1,068 |
$187K |
| S0190 |
Mifepristone, oral, 200 mg |
3,082 |
3,074 |
$179K |
| 81025 |
|
67,349 |
63,209 |
$169K |
| 99213 |
|
5,094 |
5,016 |
$154K |
| J7298 |
Mirena, 52 mg |
207 |
206 |
$135K |
| Q0144 |
Azithromycin dihydrate, oral |
4,028 |
3,979 |
$130K |
| 76815 |
|
1,397 |
1,373 |
$111K |
| 99202 |
|
3,120 |
3,113 |
$110K |
| S0191 |
Misoprostol, oral, 200 mcg |
3,742 |
3,715 |
$99K |
| 58301 |
|
2,276 |
1,124 |
$95K |
| G9920 |
Scrning perf and negative |
3,148 |
3,125 |
$79K |
| 87563 |
|
3,680 |
3,668 |
$66K |
| 99000 |
|
6,135 |
6,114 |
$61K |
| 76830 |
|
887 |
874 |
$42K |
| 11976 |
|
951 |
492 |
$42K |
| 90649 |
|
219 |
219 |
$33K |
| 88142 |
|
1,798 |
1,795 |
$27K |
| S4993 |
Contraceptive pills for bc |
1,147 |
1,142 |
$21K |
| 85018 |
|
4,107 |
3,997 |
$18K |
| J7296 |
Kyleena, 19.5 mg |
26 |
26 |
$15K |
| 01966 |
|
1,686 |
1,672 |
$12K |
| 86592 |
|
2,656 |
2,651 |
$9K |
| 81002 |
|
3,825 |
3,762 |
$7K |
| T1014 |
Telehealth transmit, per min |
1,422 |
1,398 |
$6K |
| 86901 |
|
2,167 |
2,112 |
$6K |
| 11982 |
|
119 |
66 |
$5K |
| 99214 |
|
105 |
102 |
$5K |
| 99203 |
|
74 |
74 |
$5K |
| 59841 |
|
19 |
12 |
$4K |
| G2012 |
Brief check in by md/qhp |
373 |
364 |
$3K |
| 99211 |
|
173 |
171 |
$3K |
| 99201 |
|
96 |
96 |
$3K |
| Q0111 |
Wet mounts/ w preparations |
250 |
248 |
$2K |
| 86703 |
|
117 |
117 |
$1K |
| 87529 |
|
85 |
84 |
$1K |
| G9919 |
Scrn nd pos nd prov of rec |
40 |
38 |
$615.68 |
| J0696 |
Ceftriaxone sodium injection |
27 |
27 |
$406.35 |
| 99152 |
|
12 |
12 |
$278.96 |
| A4268 |
Female condom |
28 |
28 |
$146.81 |
| A4649 |
Surgical supplies |
12 |
12 |
$43.75 |