| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
305 |
253 |
$30K |
| Q0144 |
Azithromycin dihydrate, oral, capsules/powder, 1 gram |
428 |
362 |
$22K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
185 |
166 |
$16K |
| S0190 |
Mifepristone, oral, 200 mg |
82 |
73 |
$6K |
| 59841 |
|
14 |
12 |
$4K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
12 |
12 |
$2K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
15 |
13 |
$2K |
| J8499 |
Prescription drug, oral, non chemotherapeutic, nos |
442 |
374 |
$1K |
| S0191 |
Misoprostol, oral, 200 mcg |
106 |
97 |
$364.85 |
| 36415 |
Collection of venous blood by venipuncture |
13 |
12 |
$36.00 |
| 81025 |
|
141 |
128 |
$9.30 |