| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
63 |
63 |
$0.00 |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
331 |
325 |
$0.00 |
| 76998 |
|
43 |
43 |
$0.00 |
| J8499 |
Prescription drug, oral, non chemotherapeutic, nos |
1,047 |
340 |
$0.00 |
| S0190 |
Mifepristone, oral, 200 mg |
65 |
62 |
$0.00 |
| 99152 |
|
47 |
47 |
$0.00 |
| S0199 |
Medically induced abortion by oral ingestion of medication including all associated services and supplies (e.g., patient counseling, office visits, confirmation of pregnancy by hcg, ultrasound to confirm duration of pregnancy, ultrasound to confirm completion of abortion) except drugs |
65 |
62 |
$0.00 |
| 59841 |
|
48 |
47 |
$0.00 |
| S0191 |
Misoprostol, oral, 200 mcg |
79 |
76 |
$0.00 |