| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99205 |
Prolong outpt/office vis |
644 |
579 |
$78K |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
941 |
863 |
$46K |
| 99401 |
|
541 |
503 |
$13K |
| 59841 |
|
104 |
40 |
$6K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
114 |
89 |
$6K |
| S0190 |
Mifepristone, oral, 200 mg |
212 |
95 |
$4K |
| 99441 |
|
100 |
98 |
$4K |
| 99152 |
|
92 |
37 |
$665.75 |
| 99402 |
|
16 |
13 |
$519.73 |
| S0191 |
Misoprostol, oral, 200 mcg |
303 |
135 |
$255.84 |
| A4550 |
Surgical trays |
102 |
40 |
$221.94 |
| J8499 |
Prescription drug, oral, non chemotherapeutic, nos |
182 |
55 |
$138.90 |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
94 |
38 |
$43.58 |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
68 |
26 |
$2.84 |