| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J3490 |
Drugs unclassified injection |
59,274 |
45,397 |
$1.09M |
| J7307 |
Etonogestrel implant system |
1,761 |
1,747 |
$1.04M |
| S4993 |
Contraceptive pills for bc |
9,853 |
9,560 |
$755K |
| 99211 |
|
32,276 |
29,978 |
$708K |
| 99212 |
|
15,066 |
14,223 |
$698K |
| 99213 |
|
12,533 |
11,876 |
$678K |
| 99214 |
|
6,740 |
6,603 |
$507K |
| 99202 |
|
5,521 |
5,491 |
$482K |
| S0199 |
Med abortion inc all ex drug |
3,698 |
3,628 |
$382K |
| 99203 |
|
2,472 |
2,469 |
$364K |
| 99201 |
|
5,314 |
5,040 |
$331K |
| 99204 |
|
2,066 |
2,066 |
$311K |
| 87806 |
|
20,542 |
17,986 |
$275K |
| 11981 |
|
1,716 |
1,704 |
$259K |
| A4267 |
Male condom |
26,912 |
25,743 |
$224K |
| J7304 |
Contraceptive hormone patch |
290 |
288 |
$140K |
| 87661 |
|
9,069 |
9,020 |
$130K |
| 11976 |
|
1,316 |
708 |
$60K |
| S9445 |
Pt education noc individ |
3,982 |
3,982 |
$51K |
| 81025 |
|
30,156 |
29,151 |
$43K |
| S0190 |
Mifepristone, oral, 200 mg |
3,594 |
3,545 |
$42K |
| 99402 |
|
1,192 |
1,174 |
$38K |
| 76815 |
|
4,629 |
4,475 |
$37K |
| 99401 |
|
1,859 |
1,845 |
$35K |
| 58300 |
|
589 |
304 |
$32K |
| S5000 |
Prescription drug, generic |
4,034 |
3,735 |
$32K |
| 99000 |
|
16,352 |
15,896 |
$30K |
| 59840 |
|
1,646 |
823 |
$26K |
| 83986 |
|
8,404 |
7,515 |
$11K |
| Q0111 |
Wet mounts/ w preparations |
7,204 |
6,826 |
$10K |
| 0270 |
|
8,271 |
4,655 |
$10K |
| Q0144 |
Azithromycin dihydrate, oral |
4,748 |
4,278 |
$8K |
| J0696 |
Ceftriaxone sodium injection |
1,863 |
1,777 |
$5K |
| Q3014 |
Telehealth facility fee |
367 |
365 |
$4K |
| 87591 |
|
4,490 |
4,413 |
$4K |
| 58301 |
|
200 |
101 |
$4K |
| J7303 |
Contraceptive vaginal ring |
41 |
37 |
$4K |
| 87491 |
|
3,287 |
3,267 |
$4K |
| 85018 |
|
3,186 |
2,998 |
$3K |
| S0191 |
Misoprostol, oral, 200 mcg |
4,127 |
4,032 |
$2K |
| J8499 |
Oral prescrip drug non chemo |
837 |
563 |
$2K |
| G2012 |
Brief check in by md/qhp |
246 |
238 |
$2K |
| 81002 |
|
1,390 |
1,357 |
$2K |
| 76817 |
|
17 |
17 |
$986.04 |
| T1014 |
Telehealth transmit, per min |
299 |
299 |
$628.40 |
| 11982 |
|
257 |
127 |
$551.22 |
| 99152 |
|
279 |
261 |
$461.37 |
| 86901 |
|
953 |
910 |
$430.96 |
| J0561 |
Penicillin g benzathine inj |
69 |
50 |
$216.23 |
| J3010 |
Fentanyl citrate injection |
599 |
584 |
$179.18 |
| J2250 |
Inj midazolam hydrochloride |
543 |
534 |
$65.11 |
| 99070 |
|
1,949 |
1,135 |
$52.00 |
| 0250 |
|
106 |
103 |
$0.01 |