| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
1,810 |
1,349 |
$48K |
| 59840 |
|
605 |
458 |
$31K |
| S0190 |
Mifepristone, oral, 200 mg |
1,769 |
1,326 |
$12K |
| 76998 |
|
36 |
34 |
$5K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
128 |
100 |
$5K |
| S0191 |
Misoprostol, oral, 200 mcg |
2,150 |
1,611 |
$3K |
| J2788 |
Injection, rho d immune globulin, human, minidose, 50 micrograms (250 i.u.) |
88 |
86 |
$2K |
| 99070 |
|
577 |
435 |
$1K |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
348 |
248 |
$985.18 |
| 86906 |
|
369 |
287 |
$847.34 |
| 85018 |
|
699 |
521 |
$465.81 |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
21 |
16 |
$0.00 |
| J8499 |
Prescription drug, oral, non chemotherapeutic, nos |
75 |
55 |
$0.00 |