| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
|
6,829 |
6,349 |
$832K |
| 99214 |
|
3,465 |
3,273 |
$685K |
| 99203 |
|
1,716 |
1,678 |
$537K |
| 99212 |
|
4,618 |
4,444 |
$433K |
| J3490 |
Drugs unclassified injection |
11,201 |
9,958 |
$380K |
| S4993 |
Contraceptive pills for bc |
3,094 |
3,090 |
$338K |
| 99202 |
|
1,612 |
1,582 |
$304K |
| 99204 |
|
501 |
501 |
$194K |
| J7307 |
Etonogestrel implant system |
183 |
183 |
$160K |
| 87806 |
|
4,331 |
3,228 |
$109K |
| 58300 |
|
612 |
300 |
$54K |
| A4267 |
Male condom |
9,288 |
9,149 |
$53K |
| 99401 |
|
2,293 |
2,282 |
$44K |
| 87491 |
|
1,709 |
1,661 |
$43K |
| 11976 |
|
683 |
344 |
$39K |
| 11981 |
|
171 |
171 |
$37K |
| 99211 |
|
582 |
517 |
$34K |
| S5000 |
Prescription drug, generic |
4,859 |
4,601 |
$32K |
| 81025 |
|
8,880 |
8,650 |
$31K |
| 87591 |
|
1,744 |
1,691 |
$28K |
| S9445 |
Pt education noc individ |
1,930 |
1,930 |
$25K |
| 83986 |
|
8,234 |
6,649 |
$22K |
| Q0111 |
Wet mounts/ w preparations |
5,017 |
4,874 |
$18K |
| S0199 |
Med abortion inc all ex drug |
43 |
43 |
$15K |
| J7300 |
Intra copp contra (paragard) |
16 |
16 |
$11K |
| 99000 |
|
2,947 |
2,932 |
$10K |
| 86703 |
|
492 |
385 |
$5K |
| 81002 |
|
2,119 |
2,065 |
$4K |
| 58301 |
|
78 |
39 |
$3K |
| Q0144 |
Azithromycin dihydrate, oral |
591 |
584 |
$2K |
| 87389 |
|
141 |
141 |
$2K |
| 87210 |
|
444 |
436 |
$1K |
| 99201 |
|
12 |
12 |
$1K |
| 82120 |
|
427 |
420 |
$1K |
| 99402 |
|
27 |
27 |
$858.33 |
| 86592 |
|
235 |
235 |
$584.35 |
| S0190 |
Mifepristone, oral, 200 mg |
13 |
13 |
$347.66 |
| J0696 |
Ceftriaxone sodium injection |
34 |
33 |
$184.84 |
| S0191 |
Misoprostol, oral, 200 mcg |
13 |
13 |
$24.30 |