| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J3490 |
Drugs unclassified injection |
29,025 |
24,615 |
$1.16M |
| 99213 |
|
7,678 |
7,361 |
$619K |
| S4993 |
Contraceptive pills for bc |
6,188 |
6,103 |
$609K |
| 99214 |
|
4,840 |
4,704 |
$600K |
| J7307 |
Etonogestrel implant system |
524 |
523 |
$560K |
| 99212 |
|
9,052 |
8,812 |
$558K |
| 99211 |
|
10,896 |
9,942 |
$471K |
| 99203 |
|
1,828 |
1,796 |
$435K |
| S0199 |
Med abortion inc all ex drug |
590 |
590 |
$288K |
| 99201 |
|
2,103 |
1,942 |
$206K |
| 87806 |
|
7,853 |
6,710 |
$175K |
| A4267 |
Male condom |
20,468 |
20,131 |
$173K |
| 99202 |
|
1,052 |
1,052 |
$157K |
| 99204 |
|
396 |
396 |
$139K |
| 11981 |
|
459 |
459 |
$124K |
| 81025 |
|
24,440 |
23,840 |
$121K |
| 11976 |
|
979 |
492 |
$73K |
| 87491 |
|
2,724 |
2,668 |
$32K |
| 99000 |
|
8,636 |
8,559 |
$28K |
| S9445 |
Pt education noc individ |
2,153 |
2,153 |
$27K |
| 87591 |
|
2,724 |
2,663 |
$26K |
| Z1032 |
|
173 |
173 |
$20K |
| 58300 |
|
205 |
105 |
$20K |
| Z1034 |
|
351 |
309 |
$19K |
| S5000 |
Prescription drug, generic |
3,324 |
3,107 |
$19K |
| 86703 |
|
1,891 |
1,765 |
$18K |
| J7304 |
Contraceptive hormone patch |
50 |
50 |
$17K |
| 87389 |
|
1,087 |
1,085 |
$16K |
| 83986 |
|
6,114 |
5,351 |
$15K |
| 86592 |
|
5,597 |
5,575 |
$15K |
| S0190 |
Mifepristone, oral, 200 mg |
266 |
266 |
$12K |
| J7298 |
Mirena, 52 mg |
12 |
12 |
$8K |
| Q0111 |
Wet mounts/ w preparations |
2,192 |
2,122 |
$8K |
| Q0144 |
Azithromycin dihydrate, oral |
1,812 |
1,777 |
$7K |
| 82120 |
|
2,473 |
2,421 |
$7K |
| 87210 |
|
2,476 |
2,436 |
$7K |
| 58301 |
|
142 |
74 |
$5K |
| J7303 |
Contraceptive vaginal ring |
73 |
73 |
$5K |
| 76817 |
|
25 |
25 |
$2K |
| 85018 |
|
282 |
281 |
$2K |
| 81002 |
|
742 |
725 |
$1K |
| J0696 |
Ceftriaxone sodium injection |
221 |
213 |
$1K |
| S0191 |
Misoprostol, oral, 200 mcg |
294 |
292 |
$627.23 |
| 99401 |
|
19 |
19 |
$362.33 |
| 86901 |
|
55 |
50 |
$124.67 |
| Z7610 |
|
14 |
13 |
$77.88 |
| 99070 |
|
219 |
181 |
$1.36 |
| 36416 |
|
12 |
12 |
$0.00 |