| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
|
7,763 |
7,308 |
$1.42M |
| 99213 |
|
9,196 |
8,766 |
$1.09M |
| 87806 |
|
25,528 |
21,139 |
$697K |
| 99203 |
|
2,379 |
2,308 |
$655K |
| S4993 |
Contraceptive pills for bc |
5,071 |
5,037 |
$597K |
| 99212 |
|
6,600 |
6,422 |
$577K |
| 99204 |
|
1,474 |
1,472 |
$493K |
| 99202 |
|
2,970 |
2,911 |
$489K |
| J3490 |
Drugs unclassified injection |
11,696 |
10,279 |
$432K |
| 99211 |
|
5,570 |
5,043 |
$323K |
| J7307 |
Etonogestrel implant system |
374 |
374 |
$290K |
| 99201 |
|
2,271 |
2,110 |
$248K |
| 90651 |
|
558 |
556 |
$127K |
| J7298 |
Mirena, 52 mg |
184 |
184 |
$113K |
| 58300 |
|
1,063 |
548 |
$97K |
| 11981 |
|
378 |
377 |
$84K |
| S9445 |
Pt education noc individ |
5,617 |
5,617 |
$71K |
| 99000 |
|
16,543 |
16,429 |
$70K |
| 81025 |
|
18,780 |
18,407 |
$61K |
| J7304 |
Contraceptive hormone patch |
91 |
91 |
$57K |
| S5000 |
Prescription drug, generic |
8,023 |
7,361 |
$55K |
| 83986 |
|
11,219 |
9,444 |
$35K |
| 11976 |
|
569 |
290 |
$33K |
| A4267 |
Male condom |
2,943 |
2,937 |
$26K |
| Q0111 |
Wet mounts/ w preparations |
5,691 |
5,592 |
$21K |
| J7300 |
Intra copp contra (paragard) |
26 |
26 |
$15K |
| 99401 |
|
751 |
731 |
$14K |
| J7303 |
Contraceptive vaginal ring |
130 |
128 |
$13K |
| 57454 |
|
216 |
110 |
$12K |
| S0199 |
Med abortion inc all ex drug |
24 |
24 |
$10K |
| 82120 |
|
1,797 |
1,734 |
$9K |
| S5199 |
Personal care item nos each |
2,309 |
2,305 |
$7K |
| 58301 |
|
238 |
123 |
$6K |
| Q0144 |
Azithromycin dihydrate, oral |
1,036 |
869 |
$6K |
| 87210 |
|
1,214 |
1,193 |
$6K |
| 81002 |
|
1,993 |
1,961 |
$4K |
| 57452 |
|
82 |
41 |
$3K |
| S0190 |
Mifepristone, oral, 200 mg |
12 |
12 |
$729.22 |
| J0696 |
Ceftriaxone sodium injection |
73 |
42 |
$358.83 |
| 85018 |
|
25 |
25 |
$51.49 |
| S0191 |
Misoprostol, oral, 200 mcg |
15 |
14 |
$41.27 |
| T1999 |
Noc retail items andsupplies |
14 |
13 |
$9.08 |