| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
118 |
113 |
$12K |
| 99205 |
Prolong outpt/office vis |
32 |
31 |
$6K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
33 |
33 |
$3K |
| S0190 |
Mifepristone, oral, 200 mg |
41 |
41 |
$3K |
| 99402 |
|
52 |
51 |
$2K |
| 99401 |
|
42 |
41 |
$1K |
| S0191 |
Misoprostol, oral, 200 mcg |
58 |
57 |
$300.63 |
| J8499 |
Prescription drug, oral, non chemotherapeutic, nos |
31 |
12 |
$4.53 |
| 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 |
41 |
41 |
$0.00 |