| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J3490 |
Drugs unclassified injection |
23,822 |
20,554 |
$892K |
| J7307 |
Etonogestrel implant system |
773 |
770 |
$749K |
| 99211 |
|
13,757 |
13,151 |
$637K |
| 99213 |
|
5,298 |
5,020 |
$635K |
| 99212 |
|
5,025 |
4,932 |
$438K |
| 99203 |
|
1,137 |
1,108 |
$355K |
| 99214 |
|
1,849 |
1,790 |
$324K |
| S4993 |
Contraceptive pills for bc |
4,373 |
4,346 |
$322K |
| 87806 |
|
11,561 |
9,138 |
$275K |
| 99202 |
|
1,284 |
1,279 |
$231K |
| 11981 |
|
701 |
701 |
$177K |
| A4267 |
Male condom |
21,879 |
21,311 |
$147K |
| 99201 |
|
1,025 |
984 |
$106K |
| 58300 |
|
932 |
476 |
$94K |
| 81025 |
|
18,803 |
18,142 |
$93K |
| 99401 |
|
4,003 |
3,935 |
$76K |
| 11976 |
|
1,027 |
525 |
$67K |
| J7304 |
Contraceptive hormone patch |
156 |
156 |
$67K |
| 99204 |
|
140 |
140 |
$53K |
| S9445 |
Pt education noc individ |
3,034 |
3,034 |
$39K |
| S5000 |
Prescription drug, generic |
5,186 |
4,804 |
$35K |
| S0199 |
Med abortion inc all ex drug |
61 |
61 |
$28K |
| 87491 |
|
2,273 |
2,245 |
$27K |
| J7300 |
Intra copp contra (paragard) |
39 |
39 |
$26K |
| 99000 |
|
7,567 |
7,545 |
$25K |
| 86703 |
|
2,390 |
2,134 |
$23K |
| 87591 |
|
2,287 |
2,259 |
$20K |
| 83986 |
|
7,230 |
5,916 |
$20K |
| 59840 |
|
92 |
56 |
$18K |
| Q0111 |
Wet mounts/ w preparations |
3,859 |
3,774 |
$14K |
| Q0144 |
Azithromycin dihydrate, oral |
2,146 |
2,101 |
$10K |
| 58301 |
|
234 |
129 |
$7K |
| 86592 |
|
2,465 |
2,454 |
$7K |
| 87389 |
|
413 |
413 |
$6K |
| S0190 |
Mifepristone, oral, 200 mg |
76 |
76 |
$4K |
| 82120 |
|
988 |
914 |
$3K |
| 99402 |
|
102 |
101 |
$3K |
| 81002 |
|
1,668 |
1,626 |
$3K |
| J0696 |
Ceftriaxone sodium injection |
538 |
506 |
$3K |
| 87210 |
|
876 |
854 |
$3K |
| J7303 |
Contraceptive vaginal ring |
25 |
25 |
$2K |
| 76817 |
|
25 |
25 |
$2K |
| Z7610 |
|
57 |
52 |
$370.03 |
| 85018 |
|
188 |
188 |
$343.05 |
| S0191 |
Misoprostol, oral, 200 mcg |
104 |
103 |
$219.25 |
| 86901 |
|
28 |
27 |
$65.65 |