| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0199 |
Med abortion inc all ex drug |
155 |
151 |
$74K |
| J3490 |
Drugs unclassified injection |
1,530 |
1,381 |
$56K |
| 99212 |
|
1,237 |
1,108 |
$32K |
| 87806 |
|
1,177 |
1,170 |
$30K |
| A4267 |
Male condom |
784 |
752 |
$13K |
| 76817 |
|
247 |
211 |
$11K |
| 81025 |
|
2,750 |
2,428 |
$7K |
| S4993 |
Contraceptive pills for bc |
54 |
51 |
$7K |
| S0190 |
Mifepristone, oral, 200 mg |
111 |
107 |
$7K |
| 99213 |
|
195 |
156 |
$7K |
| 99214 |
|
126 |
83 |
$6K |
| Q0144 |
Azithromycin dihydrate, oral |
251 |
225 |
$5K |
| 99000 |
|
600 |
599 |
$3K |
| 99202 |
|
40 |
40 |
$2K |
| 87481 |
|
54 |
49 |
$1K |
| 87661 |
|
54 |
49 |
$1K |
| 87799 |
|
55 |
49 |
$894.83 |
| S0191 |
Misoprostol, oral, 200 mcg |
87 |
83 |
$843.19 |
| 99201 |
|
24 |
24 |
$735.44 |
| 86592 |
|
159 |
158 |
$575.00 |
| 99211 |
|
32 |
24 |
$437.80 |
| 85018 |
|
88 |
85 |
$146.97 |
| G9920 |
Scrning perf and negative |
14 |
14 |
$145.00 |
| 86901 |
|
14 |
14 |
$34.44 |