| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J1050 |
Medroxyprogesterone acetate |
4,852 |
4,764 |
$448K |
| S4993 |
Contraceptive pills for bc |
5,319 |
4,664 |
$381K |
| 99213 |
|
5,996 |
5,792 |
$359K |
| 99214 |
|
3,370 |
3,229 |
$301K |
| 76817 |
|
2,151 |
2,067 |
$225K |
| 87806 |
|
6,396 |
6,222 |
$196K |
| J7307 |
Etonogestrel implant system |
181 |
178 |
$157K |
| 99202 |
|
2,540 |
2,463 |
$155K |
| 99212 |
|
3,457 |
3,347 |
$133K |
| S0190 |
Mifepristone, oral, 200 mg |
1,600 |
1,573 |
$128K |
| 96372 |
|
5,364 |
5,233 |
$91K |
| S0199 |
Med abortion inc all ex drug |
560 |
555 |
$80K |
| S2260 |
Induced abortion 17-24 weeks |
324 |
315 |
$75K |
| 81025 |
|
9,076 |
8,776 |
$72K |
| 99203 |
|
715 |
698 |
$70K |
| 99201 |
|
1,691 |
1,637 |
$59K |
| 99204 |
|
416 |
410 |
$58K |
| 58300 |
|
149 |
145 |
$33K |
| G0444 |
Depression screen annual |
1,733 |
1,677 |
$24K |
| 11982 |
|
112 |
110 |
$24K |
| 87210 |
|
3,881 |
2,412 |
$21K |
| 99211 |
|
1,117 |
1,086 |
$20K |
| 36415 |
|
2,350 |
2,240 |
$14K |
| 11981 |
|
92 |
92 |
$11K |
| S0191 |
Misoprostol, oral, 200 mcg |
1,828 |
1,702 |
$5K |
| 83986 |
|
1,410 |
1,369 |
$5K |
| 96127 |
|
1,367 |
1,321 |
$4K |
| G8510 |
Scr dep neg, no plan reqd |
371 |
364 |
$4K |
| Q3014 |
Telehealth facility fee |
113 |
111 |
$3K |
| 85018 |
|
986 |
946 |
$2K |
| 86901 |
|
692 |
663 |
$2K |
| 99152 |
|
25 |
25 |
$1K |
| Q0091 |
Obtaining screen pap smear |
97 |
96 |
$902.00 |
| S0119 |
Ondansetron 4 mg |
1,172 |
1,156 |
$744.50 |
| 99459 |
|
38 |
38 |
$701.71 |
| 36416 |
|
286 |
259 |
$668.88 |
| 99000 |
|
3,159 |
2,905 |
$524.14 |
| J8499 |
Oral prescrip drug non chemo |
12 |
12 |
$375.74 |
| A4550 |
Surgical trays |
180 |
169 |
$48.75 |
| 81002 |
|
12 |
12 |
$36.43 |
| J3010 |
Fentanyl citrate injection |
37 |
37 |
$26.93 |
| J2250 |
Inj midazolam hydrochloride |
37 |
37 |
$10.00 |
| 59840 |
|
44 |
39 |
$0.00 |