| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J3490 |
Drugs unclassified injection |
14,894 |
12,461 |
$516K |
| 99211 |
|
8,708 |
7,820 |
$506K |
| 99213 |
|
3,622 |
3,382 |
$491K |
| S4993 |
Contraceptive pills for bc |
3,527 |
3,517 |
$348K |
| 99212 |
|
3,480 |
3,334 |
$347K |
| 99203 |
|
881 |
865 |
$284K |
| 99214 |
|
1,005 |
953 |
$213K |
| 99202 |
|
957 |
952 |
$186K |
| 99201 |
|
1,375 |
1,250 |
$170K |
| 87806 |
|
6,309 |
4,797 |
$158K |
| J7307 |
Etonogestrel implant system |
184 |
184 |
$155K |
| A4267 |
Male condom |
11,572 |
11,312 |
$65K |
| 11981 |
|
184 |
184 |
$41K |
| S9445 |
Pt education noc individ |
2,715 |
2,715 |
$34K |
| 81025 |
|
11,050 |
10,649 |
$34K |
| 99401 |
|
1,148 |
1,140 |
$22K |
| S5000 |
Prescription drug, generic |
2,991 |
2,839 |
$21K |
| 99204 |
|
52 |
52 |
$21K |
| 57454 |
|
303 |
152 |
$18K |
| 58300 |
|
183 |
91 |
$17K |
| 99000 |
|
4,628 |
4,593 |
$16K |
| J7304 |
Contraceptive hormone patch |
54 |
54 |
$15K |
| J7303 |
Contraceptive vaginal ring |
182 |
182 |
$14K |
| 83986 |
|
4,129 |
3,328 |
$11K |
| 99402 |
|
324 |
324 |
$10K |
| Q0111 |
Wet mounts/ w preparations |
2,676 |
2,625 |
$10K |
| 11976 |
|
132 |
69 |
$7K |
| 86703 |
|
518 |
411 |
$5K |
| Q0144 |
Azithromycin dihydrate, oral |
967 |
945 |
$4K |
| 87491 |
|
303 |
288 |
$3K |
| 87591 |
|
304 |
289 |
$3K |
| 58301 |
|
78 |
41 |
$2K |
| 81002 |
|
1,265 |
1,241 |
$2K |
| 86592 |
|
271 |
270 |
$661.53 |
| J0696 |
Ceftriaxone sodium injection |
80 |
76 |
$406.76 |
| 87389 |
|
12 |
12 |
$182.34 |