| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
|
4,540 |
4,341 |
$930K |
| 99211 |
|
12,038 |
10,840 |
$740K |
| 99213 |
|
5,532 |
5,082 |
$713K |
| 99203 |
|
1,910 |
1,835 |
$604K |
| 99212 |
|
5,949 |
5,576 |
$586K |
| J3490 |
Drugs unclassified injection |
14,302 |
12,039 |
$526K |
| S4993 |
Contraceptive pills for bc |
5,480 |
5,444 |
$488K |
| 99202 |
|
2,069 |
1,997 |
$388K |
| J7307 |
Etonogestrel implant system |
302 |
301 |
$265K |
| 87806 |
|
8,565 |
6,723 |
$216K |
| 99204 |
|
489 |
468 |
$186K |
| 99201 |
|
1,204 |
1,135 |
$149K |
| A4267 |
Male condom |
13,025 |
12,786 |
$107K |
| J7304 |
Contraceptive hormone patch |
294 |
294 |
$91K |
| 11981 |
|
302 |
302 |
$69K |
| 81025 |
|
16,956 |
16,234 |
$59K |
| 58300 |
|
568 |
277 |
$53K |
| S9445 |
Pt education noc individ |
3,607 |
3,607 |
$46K |
| 11976 |
|
707 |
356 |
$41K |
| J7303 |
Contraceptive vaginal ring |
505 |
503 |
$38K |
| S5000 |
Prescription drug, generic |
5,526 |
5,222 |
$35K |
| 83986 |
|
9,844 |
7,989 |
$27K |
| 57454 |
|
401 |
201 |
$25K |
| Q0111 |
Wet mounts/ w preparations |
5,913 |
5,731 |
$22K |
| 99401 |
|
999 |
999 |
$19K |
| 86703 |
|
1,366 |
1,101 |
$14K |
| 58301 |
|
425 |
216 |
$13K |
| 99000 |
|
3,440 |
3,416 |
$12K |
| J7300 |
Intra copp contra (paragard) |
13 |
13 |
$9K |
| 87491 |
|
548 |
518 |
$7K |
| 87591 |
|
577 |
547 |
$7K |
| Q0144 |
Azithromycin dihydrate, oral |
1,204 |
1,169 |
$5K |
| 81002 |
|
2,303 |
2,230 |
$4K |
| 82120 |
|
593 |
575 |
$2K |
| 87210 |
|
575 |
557 |
$2K |
| J0696 |
Ceftriaxone sodium injection |
256 |
216 |
$1K |
| 99402 |
|
14 |
14 |
$445.06 |
| 86592 |
|
139 |
139 |
$416.08 |
| S5001 |
Prescription drug,brand name |
12 |
12 |
$145.00 |