| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J7307 |
Etonogestrel implant system |
335 |
314 |
$385K |
| 99213 |
|
3,728 |
3,519 |
$327K |
| 99214 |
|
1,781 |
1,727 |
$249K |
| 99202 |
|
1,575 |
1,565 |
$241K |
| J3490 |
Drugs unclassified injection |
4,620 |
3,867 |
$175K |
| S4993 |
Contraceptive pills for bc |
1,288 |
1,272 |
$150K |
| 87806 |
|
5,507 |
4,844 |
$147K |
| 99212 |
|
1,986 |
1,908 |
$140K |
| 99204 |
|
341 |
338 |
$100K |
| 90651 |
|
323 |
318 |
$90K |
| 11981 |
|
332 |
311 |
$86K |
| 99203 |
|
360 |
355 |
$85K |
| 87661 |
|
1,450 |
1,428 |
$46K |
| 99211 |
|
1,293 |
1,205 |
$38K |
| 99201 |
|
328 |
326 |
$36K |
| 99401 |
|
1,838 |
1,769 |
$35K |
| A4267 |
Male condom |
2,377 |
2,317 |
$22K |
| 99000 |
|
3,436 |
3,397 |
$13K |
| 81025 |
|
3,573 |
3,467 |
$11K |
| S9445 |
Pt education noc individ |
808 |
808 |
$10K |
| Q0111 |
Wet mounts/ w preparations |
2,216 |
2,122 |
$9K |
| S5000 |
Prescription drug, generic |
1,233 |
1,130 |
$9K |
| 83986 |
|
2,882 |
2,518 |
$9K |
| 58300 |
|
86 |
43 |
$9K |
| S0199 |
Med abortion inc all ex drug |
13 |
13 |
$8K |
| 99402 |
|
157 |
156 |
$5K |
| 11976 |
|
72 |
37 |
$5K |
| S0190 |
Mifepristone, oral, 200 mg |
38 |
38 |
$3K |
| 58301 |
|
60 |
30 |
$2K |
| 99070 |
|
734 |
524 |
$2K |
| 81002 |
|
905 |
861 |
$2K |
| 99403 |
|
31 |
30 |
$1K |
| 90471 |
|
182 |
179 |
$802.72 |
| 87491 |
|
19 |
18 |
$561.06 |
| 87591 |
|
15 |
14 |
$403.91 |
| S0191 |
Misoprostol, oral, 200 mcg |
39 |
39 |
$128.52 |