| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 0520 |
|
20,215 |
9,219 |
$2.72M |
| 0514 |
|
1,603 |
883 |
$447K |
| 99213 |
|
3,542 |
3,488 |
$445K |
| J3490 |
Drugs unclassified injection |
7,382 |
6,259 |
$439K |
| S4993 |
Contraceptive pills for bc |
3,732 |
3,696 |
$381K |
| 99212 |
|
2,746 |
2,704 |
$266K |
| 99214 |
|
1,215 |
1,202 |
$259K |
| 0510 |
|
466 |
449 |
$206K |
| 87806 |
|
7,915 |
6,276 |
$202K |
| 99202 |
|
927 |
923 |
$163K |
| 99211 |
|
1,930 |
1,925 |
$127K |
| 99201 |
|
748 |
745 |
$96K |
| J7307 |
Etonogestrel implant system |
43 |
41 |
$76K |
| 0300 |
|
6,824 |
4,537 |
$48K |
| S9445 |
Pt education noc individ |
3,035 |
3,035 |
$39K |
| A4267 |
Male condom |
3,406 |
3,403 |
$31K |
| 99203 |
|
115 |
115 |
$30K |
| S5000 |
Prescription drug, generic |
1,992 |
1,858 |
$20K |
| 0270 |
|
1,749 |
1,458 |
$18K |
| 81025 |
|
4,919 |
4,867 |
$15K |
| 99402 |
|
431 |
431 |
$14K |
| 58300 |
|
100 |
51 |
$13K |
| 86703 |
|
1,197 |
976 |
$13K |
| 86780 |
|
1,089 |
1,086 |
$11K |
| S0190 |
Mifepristone, oral, 200 mg |
179 |
172 |
$11K |
| J7303 |
Contraceptive vaginal ring |
16 |
16 |
$10K |
| 0320 |
|
107 |
101 |
$9K |
| 87591 |
|
219 |
211 |
$7K |
| 83986 |
|
2,620 |
2,112 |
$7K |
| 87491 |
|
190 |
183 |
$7K |
| S0199 |
Med abortion inc all ex drug |
12 |
12 |
$6K |
| 11981 |
|
24 |
18 |
$5K |
| 87808 |
|
418 |
405 |
$4K |
| 99000 |
|
1,022 |
1,021 |
$4K |
| Q0111 |
Wet mounts/ w preparations |
846 |
838 |
$3K |
| Q3014 |
Telehealth facility fee |
111 |
109 |
$3K |
| Q0144 |
Azithromycin dihydrate, oral |
398 |
288 |
$2K |
| 86803 |
|
30 |
30 |
$420.77 |
| S0191 |
Misoprostol, oral, 200 mcg |
280 |
264 |
$221.85 |
| A4649 |
Surgical supplies |
13 |
13 |
$214.00 |
| 81002 |
|
94 |
93 |
$173.81 |
| 85018 |
|
66 |
63 |
$145.17 |