| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 0520 |
|
31,983 |
13,759 |
$4.56M |
| J7307 |
Etonogestrel implant system |
549 |
531 |
$865K |
| J3490 |
Drugs unclassified injection |
8,660 |
7,318 |
$631K |
| 0514 |
|
2,229 |
1,236 |
$597K |
| 99213 |
|
3,258 |
3,207 |
$442K |
| S4993 |
Contraceptive pills for bc |
1,831 |
1,818 |
$234K |
| 0510 |
|
749 |
718 |
$224K |
| 99214 |
|
924 |
911 |
$197K |
| 99211 |
|
3,191 |
3,174 |
$189K |
| 99212 |
|
1,916 |
1,876 |
$188K |
| 11981 |
|
445 |
437 |
$167K |
| 87806 |
|
6,098 |
5,212 |
$155K |
| 99202 |
|
597 |
589 |
$98K |
| 99203 |
|
328 |
327 |
$92K |
| 0300 |
|
12,137 |
7,971 |
$90K |
| J7304 |
Contraceptive hormone patch |
85 |
81 |
$87K |
| 11976 |
|
878 |
432 |
$78K |
| 99201 |
|
315 |
314 |
$40K |
| 90651 |
|
109 |
109 |
$29K |
| 0270 |
|
2,699 |
2,286 |
$28K |
| A4267 |
Male condom |
3,692 |
3,679 |
$28K |
| S0199 |
Med abortion inc all ex drug |
47 |
47 |
$26K |
| S9445 |
Pt education noc individ |
1,776 |
1,776 |
$23K |
| 81025 |
|
6,287 |
6,158 |
$22K |
| 86780 |
|
1,841 |
1,788 |
$20K |
| 0320 |
|
211 |
207 |
$20K |
| S0190 |
Mifepristone, oral, 200 mg |
316 |
297 |
$19K |
| 58300 |
|
66 |
39 |
$19K |
| 87491 |
|
680 |
646 |
$18K |
| 87591 |
|
663 |
629 |
$17K |
| 59840 |
|
85 |
52 |
$16K |
| S5000 |
Prescription drug, generic |
1,424 |
1,292 |
$15K |
| 86703 |
|
1,162 |
968 |
$12K |
| 86803 |
|
619 |
584 |
$8K |
| 87808 |
|
686 |
681 |
$7K |
| 83986 |
|
2,246 |
1,902 |
$6K |
| Q0111 |
Wet mounts/ w preparations |
842 |
828 |
$3K |
| 99402 |
|
61 |
61 |
$2K |
| 87801 |
|
45 |
45 |
$2K |
| Q0144 |
Azithromycin dihydrate, oral |
333 |
245 |
$2K |
| 58301 |
|
25 |
13 |
$807.70 |
| 0370 |
|
24 |
24 |
$442.56 |
| S0191 |
Misoprostol, oral, 200 mcg |
370 |
344 |
$290.09 |
| 99152 |
|
12 |
12 |
$221.28 |
| 85018 |
|
46 |
46 |
$102.02 |
| 81002 |
|
37 |
37 |
$63.64 |
| 86592 |
|
12 |
12 |
$40.69 |
| S0119 |
Ondansetron 4 mg |
27 |
27 |
$31.25 |