| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
|
2,686 |
2,468 |
$429K |
| 99213 |
|
2,945 |
2,765 |
$310K |
| 87806 |
|
8,620 |
7,254 |
$222K |
| 99203 |
|
746 |
679 |
$201K |
| J3490 |
Drugs unclassified injection |
5,481 |
4,824 |
$170K |
| S4993 |
Contraceptive pills for bc |
1,429 |
1,421 |
$169K |
| 99212 |
|
1,795 |
1,740 |
$130K |
| 99211 |
|
2,377 |
2,226 |
$123K |
| 99202 |
|
491 |
485 |
$72K |
| 99204 |
|
215 |
208 |
$62K |
| 59840 |
|
161 |
81 |
$30K |
| 58300 |
|
318 |
166 |
$30K |
| 99201 |
|
267 |
267 |
$29K |
| S9445 |
Pt education noc individ |
1,669 |
1,669 |
$21K |
| J7307 |
Etonogestrel implant system |
26 |
26 |
$21K |
| A4267 |
Male condom |
2,807 |
2,774 |
$20K |
| 99000 |
|
4,808 |
4,701 |
$18K |
| 81025 |
|
5,769 |
5,621 |
$17K |
| S5000 |
Prescription drug, generic |
2,188 |
2,020 |
$12K |
| J7300 |
Intra copp contra (paragard) |
16 |
16 |
$11K |
| 83986 |
|
3,096 |
2,639 |
$9K |
| 90651 |
|
36 |
36 |
$8K |
| S0199 |
Med abortion inc all ex drug |
13 |
12 |
$7K |
| 11981 |
|
26 |
26 |
$6K |
| Q0111 |
Wet mounts/ w preparations |
1,482 |
1,452 |
$6K |
| 76815 |
|
78 |
77 |
$5K |
| 99401 |
|
241 |
237 |
$5K |
| S5199 |
Personal care item nos each |
1,132 |
1,127 |
$3K |
| 82120 |
|
501 |
471 |
$2K |
| Q0144 |
Azithromycin dihydrate, oral |
305 |
271 |
$2K |
| 11976 |
|
24 |
12 |
$1K |
| 99152 |
|
25 |
25 |
$1K |
| 64435 |
|
27 |
27 |
$1K |
| 81002 |
|
445 |
435 |
$885.80 |
| S0190 |
Mifepristone, oral, 200 mg |
13 |
12 |
$834.91 |
| 87210 |
|
204 |
188 |
$747.29 |
| 85018 |
|
85 |
84 |
$175.08 |
| J3010 |
Fentanyl citrate injection |
26 |
26 |
$134.84 |
| J2250 |
Inj midazolam hydrochloride |
26 |
26 |
$115.87 |
| S0191 |
Misoprostol, oral, 200 mcg |
13 |
12 |
$38.60 |