| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S9430 |
Pharmacy compounding and dispensing services |
1,263 |
1,127 |
$102K |
| 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 |
66 |
62 |
$45K |
| 59840 |
|
100 |
96 |
$34K |
| 59899 |
|
108 |
107 |
$25K |
| S4993 |
Contraceptive pills for birth control |
1,128 |
744 |
$16K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
200 |
175 |
$14K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
76 |
68 |
$10K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
27 |
27 |
$4K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
62 |
56 |
$3K |
| J3490 |
Unclassified drugs |
297 |
207 |
$3K |
| 81025 |
|
351 |
295 |
$3K |
| S0190 |
Mifepristone, oral, 200 mg |
52 |
50 |
$2K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
22 |
21 |
$2K |
| 96374 |
Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance |
83 |
80 |
$1K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
43 |
37 |
$545.42 |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
58 |
55 |
$350.56 |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
62 |
50 |
$210.57 |
| 86780 |
|
56 |
53 |
$204.85 |
| A4267 |
Contraceptive supply, condom, male, each |
12 |
12 |
$84.24 |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
96 |
95 |
$60.97 |
| S0191 |
Misoprostol, oral, 200 mcg |
78 |
76 |
$58.48 |
| 87210 |
|
46 |
44 |
$47.70 |
| 83986 |
|
45 |
43 |
$29.34 |
| 81002 |
|
17 |
17 |
$12.68 |
| 64435 |
|
65 |
64 |
$0.00 |