| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 87491 |
|
545,371 |
522,915 |
$14.74M |
| 87591 |
|
543,899 |
521,423 |
$13.62M |
| S0199 |
Med abortion inc all ex drug |
3,368 |
3,355 |
$1.09M |
| J3490 |
Drugs unclassified injection |
54,848 |
51,064 |
$891K |
| 81025 |
|
66,109 |
64,868 |
$654K |
| 99212 |
|
30,016 |
29,688 |
$646K |
| 99213 |
|
23,859 |
23,616 |
$590K |
| 99211 |
|
35,136 |
34,699 |
$533K |
| 99214 |
|
11,280 |
11,198 |
$396K |
| 76817 |
|
4,299 |
4,225 |
$281K |
| A4267 |
Male condom |
39,417 |
39,055 |
$176K |
| S4993 |
Contraceptive pills for bc |
9,076 |
9,038 |
$148K |
| S0190 |
Mifepristone, oral, 200 mg |
3,305 |
3,294 |
$141K |
| 99202 |
|
3,667 |
3,650 |
$133K |
| 99000 |
|
28,824 |
28,673 |
$123K |
| 87389 |
|
9,560 |
9,556 |
$118K |
| 87806 |
|
22,144 |
22,028 |
$89K |
| 85018 |
|
4,745 |
4,694 |
$79K |
| 99203 |
|
1,258 |
1,257 |
$67K |
| 36416 |
|
12,512 |
12,464 |
$67K |
| Q0144 |
Azithromycin dihydrate, oral |
4,681 |
4,633 |
$60K |
| 59840 |
|
536 |
273 |
$59K |
| 36415 |
|
11,215 |
11,149 |
$57K |
| A4649 |
Surgical supplies |
17,349 |
14,805 |
$45K |
| S0191 |
Misoprostol, oral, 200 mcg |
3,817 |
3,796 |
$38K |
| 86901 |
|
2,323 |
2,193 |
$36K |
| 99201 |
|
1,419 |
1,414 |
$35K |
| J7307 |
Etonogestrel implant system |
64 |
64 |
$26K |
| 86703 |
|
3,855 |
3,854 |
$20K |
| 87210 |
|
6,326 |
6,255 |
$18K |
| 83986 |
|
6,322 |
6,251 |
$18K |
| 99204 |
|
293 |
293 |
$18K |
| 86592 |
|
5,591 |
5,547 |
$17K |
| 82120 |
|
6,302 |
6,231 |
$15K |
| 11981 |
|
66 |
66 |
$11K |
| 11976 |
|
239 |
120 |
$8K |
| 59841 |
|
24 |
12 |
$5K |
| 64435 |
|
231 |
230 |
$5K |
| 36000 |
|
252 |
251 |
$4K |
| S5000 |
Prescription drug, generic |
6,114 |
5,639 |
$3K |
| J7030 |
Normal saline solution infus |
256 |
255 |
$2K |
| J3010 |
Fentanyl citrate injection |
230 |
230 |
$2K |
| 11982 |
|
24 |
12 |
$1K |
| 01966 |
|
24 |
24 |
$1K |
| 76805 |
|
12 |
12 |
$691.32 |
| 76815 |
|
12 |
12 |
$593.28 |
| 88175 |
|
39 |
39 |
$565.63 |
| 81002 |
|
477 |
473 |
$430.43 |
| J1885 |
Ketorolac tromethamine inj |
57 |
57 |
$379.27 |
| A4268 |
Female condom |
31 |
31 |
$313.01 |
| 94760 |
|
73 |
73 |
$248.20 |
| 96379 |
|
40 |
40 |
$13.00 |
| 87086 |
|
50 |
50 |
$4.00 |
| 88147 |
|
371 |
368 |
$0.00 |
| 99070 |
|
120 |
100 |
$0.00 |
| 0273 |
|
13 |
13 |
$0.00 |