| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
|
2,414 |
2,132 |
$265K |
| 99214 |
|
1,527 |
1,343 |
$258K |
| J3490 |
Drugs unclassified injection |
5,464 |
4,507 |
$195K |
| 99211 |
|
3,443 |
2,929 |
$191K |
| 99212 |
|
2,064 |
1,955 |
$171K |
| 87806 |
|
6,183 |
4,710 |
$157K |
| S4993 |
Contraceptive pills for bc |
1,248 |
1,239 |
$140K |
| 99202 |
|
394 |
363 |
$63K |
| 99201 |
|
439 |
438 |
$51K |
| 99203 |
|
148 |
146 |
$38K |
| A4267 |
Male condom |
3,518 |
3,510 |
$26K |
| S9445 |
Pt education noc individ |
1,212 |
1,212 |
$15K |
| 81025 |
|
5,099 |
5,012 |
$15K |
| S0199 |
Med abortion inc all ex drug |
25 |
25 |
$12K |
| 99204 |
|
39 |
39 |
$11K |
| S5000 |
Prescription drug, generic |
1,536 |
1,369 |
$9K |
| 99000 |
|
2,425 |
2,383 |
$9K |
| 83986 |
|
2,397 |
1,969 |
$7K |
| Q0111 |
Wet mounts/ w preparations |
1,065 |
1,050 |
$4K |
| S5199 |
Personal care item nos each |
3,686 |
3,666 |
$4K |
| 76817 |
|
29 |
29 |
$2K |
| J7303 |
Contraceptive vaginal ring |
26 |
25 |
$2K |
| S0190 |
Mifepristone, oral, 200 mg |
25 |
25 |
$2K |
| Q0144 |
Azithromycin dihydrate, oral |
191 |
168 |
$1K |
| 82120 |
|
110 |
108 |
$435.80 |
| 87210 |
|
77 |
75 |
$286.36 |
| 81002 |
|
114 |
113 |
$226.54 |
| S0191 |
Misoprostol, oral, 200 mcg |
37 |
37 |
$113.75 |