| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J7307 |
Etonogestrel implant system |
1,318 |
1,284 |
$1.07M |
| S4993 |
Contraceptive pills for bc |
4,222 |
4,177 |
$728K |
| 87491 |
|
14,523 |
14,344 |
$590K |
| 87591 |
|
14,488 |
14,313 |
$577K |
| 99214 |
|
9,247 |
8,328 |
$519K |
| 99213 |
|
16,124 |
13,747 |
$511K |
| S0199 |
Med abortion inc all ex drug |
417 |
414 |
$233K |
| J1050 |
Medroxyprogesterone acetate |
3,301 |
3,214 |
$227K |
| 90651 |
|
832 |
816 |
$175K |
| 99395 |
|
2,047 |
1,883 |
$161K |
| J3490 |
Drugs unclassified injection |
5,254 |
5,044 |
$135K |
| J7304 |
Contraceptive hormone patch |
119 |
118 |
$122K |
| A4267 |
Male condom |
10,243 |
9,917 |
$117K |
| 11981 |
|
553 |
523 |
$102K |
| 87806 |
|
4,216 |
4,166 |
$95K |
| 99212 |
|
2,860 |
2,488 |
$75K |
| 99203 |
|
1,089 |
918 |
$69K |
| 58300 |
|
557 |
255 |
$51K |
| 76817 |
|
629 |
521 |
$49K |
| 90674 |
|
1,612 |
1,591 |
$48K |
| 81025 |
|
16,474 |
15,513 |
$45K |
| Q3014 |
Telehealth facility fee |
2,534 |
2,368 |
$42K |
| 11976 |
|
702 |
323 |
$40K |
| Q0144 |
Azithromycin dihydrate, oral |
1,865 |
1,820 |
$39K |
| 96156 |
|
608 |
604 |
$38K |
| 99204 |
|
314 |
305 |
$35K |
| J7300 |
Intra copp contra (paragard) |
35 |
29 |
$20K |
| 99202 |
|
472 |
352 |
$20K |
| S0190 |
Mifepristone, oral, 200 mg |
437 |
377 |
$19K |
| 90715 |
|
396 |
393 |
$18K |
| 99385 |
|
340 |
326 |
$17K |
| Q0111 |
Wet mounts/ w preparations |
3,408 |
3,306 |
$14K |
| 99211 |
|
649 |
641 |
$13K |
| 83986 |
|
3,410 |
3,308 |
$11K |
| J7298 |
Mirena, 52 mg |
12 |
12 |
$9K |
| 99000 |
|
3,336 |
3,193 |
$8K |
| 58301 |
|
222 |
108 |
$6K |
| J7303 |
Contraceptive vaginal ring |
31 |
31 |
$6K |
| 96150 |
|
615 |
615 |
$6K |
| 57454 |
|
56 |
28 |
$4K |
| 81002 |
|
1,945 |
1,870 |
$4K |
| 90471 |
|
2,215 |
2,163 |
$2K |
| 59425 |
|
28 |
25 |
$2K |
| 96151 |
|
248 |
247 |
$2K |
| 86580 |
|
154 |
153 |
$1K |
| G0444 |
Depression screen annual |
254 |
239 |
$1K |
| J0696 |
Ceftriaxone sodium injection |
218 |
214 |
$1K |
| S0191 |
Misoprostol, oral, 200 mcg |
438 |
378 |
$885.62 |
| 85018 |
|
619 |
603 |
$790.50 |
| G8431 |
Pos clin depres scrn f/u doc |
428 |
427 |
$629.21 |
| 87430 |
|
50 |
50 |
$529.13 |
| G2012 |
Brief check in by md/qhp |
32 |
32 |
$454.14 |
| G0442 |
Annual alcohol screen 15 min |
216 |
216 |
$441.67 |
| 96127 |
|
155 |
155 |
$422.72 |
| 83036 |
|
301 |
299 |
$349.16 |
| 86901 |
|
26 |
26 |
$48.98 |
| S5000 |
Prescription drug, generic |
2,349 |
1,951 |
$26.08 |
| S5001 |
Prescription drug,brand name |
362 |
362 |
$2.00 |
| G8510 |
Scr dep neg, no plan reqd |
796 |
795 |
$0.78 |
| 1160F |
|
2,393 |
2,389 |
$0.00 |
| 1159F |
|
2,393 |
2,389 |
$0.00 |
| G8417 |
Calc bmi abv up param f/u |
719 |
715 |
$0.00 |
| 3078F |
|
1,879 |
1,875 |
$0.00 |
| G8783 |
Bp scrn perf rec interval |
1,598 |
1,565 |
$0.00 |
| 99396 |
|
117 |
117 |
$0.00 |
| 4004F |
|
72 |
72 |
$0.00 |
| 99442 |
|
40 |
33 |
$0.00 |
| 1036F |
|
2,062 |
2,058 |
$0.00 |
| 3074F |
|
1,946 |
1,942 |
$0.00 |
| 2000F |
|
815 |
814 |
$0.00 |
| 3008F |
|
403 |
403 |
$0.00 |
| G8420 |
Calc bmi norm parameters |
442 |
442 |
$0.00 |
| 99441 |
|
12 |
12 |
$0.00 |