| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S4993 |
Contraceptive pills for birth control |
859 |
712 |
$40K |
| 99401 |
|
1,199 |
839 |
$31K |
| J7297 |
Levonorgestrel-releasing intrauterine contraceptive system (liletta), 52 mg |
159 |
107 |
$27K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
430 |
301 |
$25K |
| 58300 |
|
306 |
207 |
$25K |
| J7307 |
Etonogestrel (contraceptive) implant system, including implant and supplies |
51 |
26 |
$21K |
| 76817 |
|
183 |
164 |
$12K |
| 76815 |
|
131 |
125 |
$9K |
| 87806 |
|
410 |
340 |
$8K |
| 87591 |
|
121 |
116 |
$4K |
| 96372 |
|
459 |
319 |
$4K |
| 11981 |
|
50 |
26 |
$4K |
| 85018 |
|
40 |
33 |
$81.20 |
| 86901 |
|
19 |
17 |
$79.90 |
| S0191 |
Misoprostol, oral, 200 mcg |
18 |
17 |
$0.00 |
| S0190 |
Mifepristone, oral, 200 mg |
46 |
28 |
$0.00 |
| 59840 |
|
20 |
19 |
$0.00 |