| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J7307 |
Etonogestrel implant system |
1,691 |
1,687 |
$1.80M |
| J3490 |
Drugs unclassified injection |
35,809 |
28,783 |
$1.52M |
| S4993 |
Contraceptive pills for bc |
7,851 |
7,530 |
$828K |
| 99211 |
|
19,950 |
18,969 |
$596K |
| 99213 |
|
6,756 |
6,516 |
$555K |
| S0199 |
Med abortion inc all ex drug |
1,304 |
1,299 |
$526K |
| 99214 |
|
3,684 |
3,608 |
$442K |
| 99202 |
|
3,888 |
3,874 |
$397K |
| 11981 |
|
1,572 |
1,568 |
$383K |
| 99212 |
|
5,206 |
5,065 |
$352K |
| 87806 |
|
13,270 |
11,967 |
$333K |
| J7304 |
Contraceptive hormone patch |
312 |
308 |
$259K |
| A4267 |
Male condom |
21,869 |
21,428 |
$247K |
| 99203 |
|
1,405 |
1,404 |
$223K |
| 99201 |
|
2,323 |
2,282 |
$196K |
| 58300 |
|
1,207 |
621 |
$132K |
| 99204 |
|
713 |
713 |
$116K |
| 87661 |
|
3,663 |
3,648 |
$110K |
| 11976 |
|
1,236 |
638 |
$76K |
| S0190 |
Mifepristone, oral, 200 mg |
1,276 |
1,270 |
$76K |
| 59840 |
|
502 |
260 |
$70K |
| 99402 |
|
2,117 |
2,073 |
$67K |
| J7300 |
Intra copp contra (paragard) |
52 |
52 |
$57K |
| J7298 |
Mirena, 52 mg |
54 |
54 |
$54K |
| 11982 |
|
816 |
412 |
$51K |
| S9445 |
Pt education noc individ |
2,942 |
2,942 |
$37K |
| 99401 |
|
1,883 |
1,839 |
$36K |
| 81025 |
|
10,510 |
10,333 |
$33K |
| 76815 |
|
721 |
703 |
$30K |
| S5000 |
Prescription drug, generic |
2,464 |
2,246 |
$20K |
| 99000 |
|
8,060 |
7,924 |
$20K |
| J7303 |
Contraceptive vaginal ring |
58 |
54 |
$20K |
| 58301 |
|
514 |
267 |
$19K |
| 99403 |
|
353 |
353 |
$16K |
| 83986 |
|
4,823 |
4,345 |
$14K |
| Q0111 |
Wet mounts/ w preparations |
3,721 |
3,666 |
$14K |
| 99070 |
|
1,540 |
1,072 |
$7K |
| Q0144 |
Azithromycin dihydrate, oral |
1,067 |
1,007 |
$5K |
| S0191 |
Misoprostol, oral, 200 mcg |
1,412 |
1,397 |
$5K |
| 0270 |
|
512 |
307 |
$4K |
| G2012 |
Brief check in by md/qhp |
299 |
294 |
$4K |
| 99152 |
|
77 |
76 |
$4K |
| J0696 |
Ceftriaxone sodium injection |
340 |
324 |
$2K |
| 85018 |
|
638 |
617 |
$1K |
| J0561 |
Penicillin g benzathine inj |
75 |
50 |
$899.58 |
| 87491 |
|
24 |
24 |
$748.08 |
| 87591 |
|
24 |
24 |
$745.68 |
| 81002 |
|
375 |
371 |
$725.43 |
| Q3014 |
Telehealth facility fee |
63 |
63 |
$706.56 |
| 86901 |
|
232 |
228 |
$407.91 |
| J3010 |
Fentanyl citrate injection |
78 |
77 |
$248.48 |
| J2250 |
Inj midazolam hydrochloride |
78 |
77 |
$139.36 |
| T1014 |
Telehealth transmit, per min |
79 |
62 |
$135.96 |