| Code | Description | Claims | Beneficiaries | Total Paid |
| 99212 |
|
7,097 |
6,893 |
$607K |
| 99213 |
|
4,756 |
4,543 |
$588K |
| J3490 |
Drugs unclassified injection |
14,359 |
12,737 |
$567K |
| 99203 |
|
1,798 |
1,767 |
$564K |
| S4993 |
Contraceptive pills for bc |
4,435 |
4,427 |
$518K |
| 99214 |
|
2,466 |
2,410 |
$504K |
| J7307 |
Etonogestrel implant system |
431 |
430 |
$401K |
| 99202 |
|
2,064 |
2,048 |
$386K |
| 87806 |
|
6,059 |
4,536 |
$150K |
| 99204 |
|
288 |
288 |
$109K |
| 11981 |
|
439 |
439 |
$107K |
| 58300 |
|
990 |
500 |
$101K |
| 99201 |
|
734 |
724 |
$83K |
| 99401 |
|
3,985 |
3,914 |
$76K |
| A4267 |
Male condom |
11,662 |
11,446 |
$76K |
| 99211 |
|
1,322 |
1,259 |
$68K |
| 81025 |
|
10,965 |
10,666 |
$59K |
| 87491 |
|
1,874 |
1,792 |
$50K |
| S9445 |
Pt education noc individ |
2,968 |
2,968 |
$38K |
| 87591 |
|
1,857 |
1,777 |
$36K |
| J7304 |
Contraceptive hormone patch |
109 |
109 |
$30K |
| J7298 |
Mirena, 52 mg |
43 |
43 |
$29K |
| J7300 |
Intra copp contra (paragard) |
36 |
36 |
$24K |
| S5000 |
Prescription drug, generic |
3,428 |
3,301 |
$24K |
| J7303 |
Contraceptive vaginal ring |
263 |
262 |
$24K |
| 11976 |
|
315 |
159 |
$18K |
| 99000 |
|
4,521 |
4,502 |
$16K |
| 83986 |
|
5,879 |
4,819 |
$16K |
| 55250 |
|
106 |
53 |
$15K |
| 86703 |
|
1,471 |
1,184 |
$15K |
| 99402 |
|
440 |
434 |
$14K |
| Q0111 |
Wet mounts/ w preparations |
3,431 |
3,362 |
$13K |
| S0199 |
Med abortion inc all ex drug |
29 |
28 |
$10K |
| 58301 |
|
303 |
154 |
$9K |
| J7297 |
Liletta, 52 mg |
13 |
13 |
$6K |
| 76817 |
|
82 |
80 |
$6K |
| Q0144 |
Azithromycin dihydrate, oral |
1,262 |
1,233 |
$5K |
| 59840 |
|
24 |
13 |
$3K |
| 87210 |
|
502 |
491 |
$3K |
| 81002 |
|
1,359 |
1,327 |
$3K |
| 86592 |
|
754 |
753 |
$3K |
| 87389 |
|
114 |
114 |
$2K |
| 82120 |
|
496 |
487 |
$2K |
| S0190 |
Mifepristone, oral, 200 mg |
28 |
28 |
$967.22 |
| J0696 |
Ceftriaxone sodium injection |
170 |
158 |
$851.12 |
| 85018 |
|
41 |
41 |
$77.71 |
| S0191 |
Misoprostol, oral, 200 mcg |
40 |
39 |
$56.67 |
| 86901 |
|
13 |
13 |
$29.09 |