| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J7307 |
Etonogestrel implant system |
2,294 |
2,068 |
$2.60M |
| 99212 |
|
20,759 |
18,822 |
$1.34M |
| J7298 |
Mirena, 52 mg |
1,371 |
1,061 |
$1.11M |
| J3490 |
Drugs unclassified injection |
18,961 |
16,454 |
$1.01M |
| S0199 |
Med abortion inc all ex drug |
2,411 |
2,338 |
$757K |
| S4993 |
Contraceptive pills for bc |
3,576 |
3,562 |
$491K |
| A4267 |
Male condom |
19,776 |
19,629 |
$388K |
| 99202 |
|
3,201 |
2,964 |
$370K |
| 58300 |
|
3,877 |
1,968 |
$346K |
| 11981 |
|
1,608 |
1,604 |
$341K |
| 99213 |
|
4,003 |
3,944 |
$180K |
| 90651 |
|
795 |
790 |
$166K |
| J7300 |
Intra copp contra (paragard) |
228 |
200 |
$161K |
| J7296 |
Kyleena, 19.5 mg |
161 |
159 |
$136K |
| 11976 |
|
2,248 |
1,141 |
$119K |
| 59840 |
|
715 |
444 |
$111K |
| 76817 |
|
1,743 |
1,653 |
$104K |
| G9920 |
Scrning perf and negative |
2,820 |
2,811 |
$76K |
| 58301 |
|
2,299 |
1,186 |
$74K |
| Q0144 |
Azithromycin dihydrate, oral |
2,595 |
2,373 |
$68K |
| S0190 |
Mifepristone, oral, 200 mg |
1,525 |
1,520 |
$61K |
| 99211 |
|
1,167 |
812 |
$59K |
| 99000 |
|
5,080 |
5,071 |
$41K |
| 76830 |
|
482 |
480 |
$30K |
| S9445 |
Pt education noc individ |
2,304 |
2,304 |
$29K |
| S0191 |
Misoprostol, oral, 200 mcg |
1,650 |
1,640 |
$23K |
| 87491 |
|
732 |
728 |
$23K |
| 87591 |
|
732 |
729 |
$19K |
| 99201 |
|
182 |
133 |
$16K |
| 99203 |
|
95 |
95 |
$15K |
| J7301 |
Skyla, 13.5 mg |
22 |
12 |
$14K |
| 01966 |
|
381 |
378 |
$14K |
| 76815 |
|
260 |
253 |
$13K |
| 57454 |
|
140 |
71 |
$8K |
| 87661 |
|
238 |
237 |
$7K |
| Q0111 |
Wet mounts/ w preparations |
1,062 |
1,048 |
$4K |
| 86592 |
|
751 |
750 |
$3K |
| 99214 |
|
73 |
71 |
$3K |
| G2012 |
Brief check in by md/qhp |
251 |
245 |
$3K |
| 83986 |
|
340 |
339 |
$1K |
| 57061 |
|
28 |
12 |
$951.76 |
| 87481 |
|
24 |
24 |
$792.23 |
| 87799 |
|
24 |
24 |
$723.52 |
| 85018 |
|
95 |
94 |
$637.83 |
| 81025 |
|
56 |
53 |
$198.02 |
| J0696 |
Ceftriaxone sodium injection |
12 |
12 |
$40.46 |