| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J3490 |
Drugs unclassified injection |
15,753 |
12,337 |
$683K |
| 99213 |
|
6,757 |
6,516 |
$672K |
| J7307 |
Etonogestrel implant system |
505 |
501 |
$506K |
| 99214 |
|
2,751 |
2,685 |
$447K |
| S4993 |
Contraceptive pills for bc |
3,418 |
3,377 |
$399K |
| 99202 |
|
2,077 |
2,071 |
$264K |
| 99212 |
|
3,684 |
3,607 |
$243K |
| 99203 |
|
837 |
836 |
$209K |
| 87806 |
|
8,454 |
7,276 |
$170K |
| 99211 |
|
5,095 |
4,877 |
$160K |
| 99204 |
|
446 |
446 |
$133K |
| 11981 |
|
479 |
472 |
$128K |
| 99201 |
|
1,123 |
1,110 |
$108K |
| A4267 |
Male condom |
7,686 |
7,517 |
$78K |
| 58300 |
|
559 |
280 |
$63K |
| S0199 |
Med abortion inc all ex drug |
194 |
192 |
$56K |
| J7304 |
Contraceptive hormone patch |
74 |
72 |
$55K |
| 87661 |
|
2,789 |
2,770 |
$54K |
| 11976 |
|
582 |
299 |
$48K |
| 99401 |
|
2,087 |
2,059 |
$40K |
| 81025 |
|
6,343 |
6,251 |
$31K |
| 99000 |
|
6,756 |
6,633 |
$31K |
| S9445 |
Pt education noc individ |
2,052 |
2,052 |
$26K |
| J7298 |
Mirena, 52 mg |
26 |
26 |
$25K |
| 99402 |
|
688 |
682 |
$22K |
| S5000 |
Prescription drug, generic |
2,286 |
2,152 |
$18K |
| 58301 |
|
485 |
256 |
$16K |
| 83986 |
|
4,168 |
3,646 |
$10K |
| Q0111 |
Wet mounts/ w preparations |
3,236 |
3,171 |
$10K |
| S0190 |
Mifepristone, oral, 200 mg |
140 |
140 |
$7K |
| 87591 |
|
2,669 |
2,586 |
$5K |
| Q3014 |
Telehealth facility fee |
309 |
305 |
$5K |
| 76815 |
|
135 |
130 |
$5K |
| 87491 |
|
2,647 |
2,566 |
$5K |
| J7303 |
Contraceptive vaginal ring |
19 |
18 |
$3K |
| Q0144 |
Azithromycin dihydrate, oral |
538 |
479 |
$1K |
| G2012 |
Brief check in by md/qhp |
137 |
135 |
$1K |
| 81002 |
|
764 |
751 |
$1K |
| J0696 |
Ceftriaxone sodium injection |
123 |
115 |
$522.63 |
| T1014 |
Telehealth transmit, per min |
306 |
303 |
$510.85 |
| S0191 |
Misoprostol, oral, 200 mcg |
150 |
147 |
$359.67 |
| 0270 |
|
56 |
37 |
$227.25 |
| 85018 |
|
27 |
26 |
$26.90 |