Summing up usage during streaming gives twice the expected number (the one reported in the Anthropic console logs, and the one matching tokens actually sent).
UsageContent content = fromSomewhereElse();
var tokens = usage.AdditionalCounts?.GetValueOrDefault("CacheCreationInputTokens")`;
This is on next and with 10.0.1 of Microsoft.Extensions.AI.
Edit: Same with cache hits