| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J3490 |
Drugs unclassified injection |
23,693 |
19,574 |
$846K |
| J7307 |
Etonogestrel implant system |
864 |
861 |
$800K |
| 99213 |
|
5,503 |
5,133 |
$647K |
| 99211 |
|
11,242 |
10,584 |
$615K |
| 99212 |
|
6,742 |
6,446 |
$579K |
| S4993 |
Contraceptive pills for bc |
6,083 |
6,053 |
$523K |
| 99202 |
|
2,678 |
2,640 |
$475K |
| 99203 |
|
1,482 |
1,430 |
$462K |
| 87806 |
|
12,792 |
10,390 |
$314K |
| 99201 |
|
2,416 |
2,296 |
$268K |
| 11981 |
|
810 |
810 |
$196K |
| 99214 |
|
987 |
934 |
$189K |
| 87491 |
|
8,256 |
7,766 |
$186K |
| 87591 |
|
8,258 |
7,773 |
$170K |
| A4267 |
Male condom |
23,282 |
22,599 |
$152K |
| 58300 |
|
1,278 |
642 |
$136K |
| J7304 |
Contraceptive hormone patch |
300 |
299 |
$90K |
| J7300 |
Intra copp contra (paragard) |
113 |
113 |
$76K |
| S9445 |
Pt education noc individ |
5,957 |
5,957 |
$76K |
| 11976 |
|
1,041 |
527 |
$67K |
| 99204 |
|
178 |
178 |
$66K |
| 99401 |
|
3,225 |
3,178 |
$61K |
| 81025 |
|
17,819 |
17,256 |
$56K |
| J7303 |
Contraceptive vaginal ring |
444 |
444 |
$34K |
| 99000 |
|
9,308 |
9,238 |
$32K |
| S5000 |
Prescription drug, generic |
4,279 |
4,045 |
$31K |
| S0199 |
Med abortion inc all ex drug |
60 |
60 |
$27K |
| J7298 |
Mirena, 52 mg |
29 |
29 |
$22K |
| 83986 |
|
6,699 |
5,644 |
$18K |
| 86703 |
|
1,603 |
1,378 |
$17K |
| Q0144 |
Azithromycin dihydrate, oral |
2,447 |
2,372 |
$15K |
| Q0111 |
Wet mounts/ w preparations |
3,669 |
3,576 |
$13K |
| 87389 |
|
662 |
658 |
$10K |
| S0190 |
Mifepristone, oral, 200 mg |
159 |
158 |
$9K |
| 86592 |
|
3,104 |
3,058 |
$8K |
| 58301 |
|
251 |
126 |
$7K |
| 81002 |
|
1,817 |
1,784 |
$3K |
| 82120 |
|
973 |
947 |
$3K |
| 87210 |
|
995 |
971 |
$3K |
| J0696 |
Ceftriaxone sodium injection |
356 |
290 |
$2K |
| 76817 |
|
12 |
12 |
$894.85 |
| S0191 |
Misoprostol, oral, 200 mcg |
233 |
232 |
$623.37 |
| 86901 |
|
203 |
184 |
$465.08 |
| 99402 |
|
12 |
12 |
$381.48 |
| 85018 |
|
187 |
184 |
$359.29 |
| 99070 |
|
231 |
186 |
$213.38 |
| 99072 |
|
28 |
26 |
$0.02 |
| 36416 |
|
12 |
12 |
$0.00 |