| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S4993 |
Contraceptive pills for birth control |
1,661 |
1,592 |
$252K |
| 99395 |
|
1,287 |
1,286 |
$86K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
1,152 |
1,134 |
$80K |
| 99213 |
|
2,718 |
2,533 |
$75K |
| 81025 |
|
5,343 |
5,061 |
$37K |
| J7307 |
Etonogestrel (contraceptive) implant system, including implant and supplies |
40 |
40 |
$30K |
| 99385 |
|
369 |
367 |
$28K |
| A4267 |
Contraceptive supply, condom, male, each |
9,260 |
8,307 |
$24K |
| G0433 |
Infectious agent antibody detection by enzyme-linked immunosorbent assay (elisa) technique, hiv-1 and/or hiv-2, screening |
1,259 |
1,255 |
$19K |
| 99214 |
|
450 |
427 |
$16K |
| 96372 |
|
1,253 |
1,230 |
$15K |
| 99000 |
|
1,262 |
1,220 |
$13K |
| 87210 |
|
2,314 |
2,231 |
$11K |
| 99204 |
|
123 |
113 |
$7K |
| 90651 |
|
23 |
21 |
$5K |
| A4269 |
Contraceptive supply, spermicide (e.g., foam, gel), each |
273 |
267 |
$3K |
| 81002 |
|
1,037 |
997 |
$3K |
| 99212 |
|
156 |
150 |
$3K |
| J3490 |
Unclassified drugs |
35 |
32 |
$3K |
| 99211 |
|
146 |
141 |
$2K |
| 90471 |
|
56 |
50 |
$329.28 |
| A9150 |
Non-prescription drugs |
24 |
24 |
$322.00 |
| 87591 |
|
57 |
56 |
$147.40 |
| 87491 |
|
57 |
56 |
$147.40 |
| 85018 |
|
65 |
60 |
$123.38 |
| 87661 |
|
76 |
75 |
$88.44 |
| 99406 |
|
16 |
15 |
$33.54 |
| 88142 |
|
12 |
12 |
$17.02 |
| 86592 |
|
13 |
13 |
$0.00 |
| 87389 |
|
13 |
13 |
$0.00 |
| S5000 |
Prescription drug, generic |
12 |
12 |
$0.00 |