| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J7307 |
Etonogestrel implant system |
756 |
736 |
$615K |
| S4993 |
Contraceptive pills for bc |
2,465 |
2,420 |
$485K |
| 99214 |
|
5,785 |
5,387 |
$370K |
| 87491 |
|
7,237 |
7,098 |
$290K |
| 87591 |
|
7,228 |
7,088 |
$276K |
| J7304 |
Contraceptive hormone patch |
180 |
179 |
$182K |
| 99213 |
|
5,437 |
5,102 |
$170K |
| J1050 |
Medroxyprogesterone acetate |
2,355 |
2,207 |
$160K |
| J3490 |
Drugs unclassified injection |
5,688 |
5,449 |
$145K |
| S0199 |
Med abortion inc all ex drug |
185 |
178 |
$107K |
| A4267 |
Male condom |
5,209 |
5,013 |
$59K |
| 87806 |
|
2,070 |
2,051 |
$47K |
| 99212 |
|
1,500 |
1,430 |
$42K |
| 99204 |
|
279 |
277 |
$34K |
| 11981 |
|
158 |
146 |
$27K |
| 99395 |
|
281 |
274 |
$26K |
| 11976 |
|
486 |
234 |
$25K |
| 81025 |
|
8,620 |
8,111 |
$24K |
| Q3014 |
Telehealth facility fee |
1,326 |
1,256 |
$22K |
| 96156 |
|
309 |
302 |
$20K |
| 58300 |
|
196 |
97 |
$16K |
| 90674 |
|
511 |
503 |
$16K |
| 76817 |
|
179 |
151 |
$13K |
| 90651 |
|
50 |
50 |
$13K |
| S0190 |
Mifepristone, oral, 200 mg |
167 |
164 |
$12K |
| 99203 |
|
114 |
111 |
$10K |
| Q0111 |
Wet mounts/ w preparations |
2,045 |
1,980 |
$8K |
| 99000 |
|
1,964 |
1,924 |
$7K |
| 83986 |
|
2,042 |
1,977 |
$6K |
| 99211 |
|
238 |
226 |
$5K |
| 59425 |
|
50 |
46 |
$3K |
| 81002 |
|
857 |
826 |
$2K |
| 90471 |
|
686 |
676 |
$1K |
| 99385 |
|
12 |
12 |
$1K |
| Q0144 |
Azithromycin dihydrate, oral |
215 |
209 |
$1K |
| 58301 |
|
54 |
27 |
$1K |
| 99202 |
|
13 |
13 |
$944.72 |
| J0696 |
Ceftriaxone sodium injection |
145 |
141 |
$798.42 |
| S0191 |
Misoprostol, oral, 200 mcg |
168 |
163 |
$558.85 |
| G0442 |
Annual alcohol screen 15 min |
120 |
120 |
$456.90 |
| 83036 |
|
41 |
41 |
$100.88 |
| 85018 |
|
30 |
29 |
$62.97 |
| S5000 |
Prescription drug, generic |
2,629 |
2,132 |
$11.36 |
| S0197 |
Prenatal vitamins 30 day |
18 |
17 |
$4.77 |
| 1160F |
|
141 |
141 |
$0.00 |
| 1159F |
|
141 |
141 |
$0.00 |
| 3078F |
|
64 |
64 |
$0.00 |
| 3074F |
|
80 |
80 |
$0.00 |
| 2000F |
|
85 |
85 |
$0.00 |
| 1036F |
|
38 |
38 |
$0.00 |