| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
708 |
633 |
$61K |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
1,469 |
1,315 |
$56K |
| 99401 |
|
1,778 |
1,621 |
$31K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
219 |
205 |
$13K |
| 36416 |
|
1,670 |
1,525 |
$5K |
| 86901 |
|
1,649 |
1,518 |
$3K |
| 85018 |
|
1,674 |
1,533 |
$3K |
| 99402 |
|
62 |
60 |
$3K |
| J8499 |
Prescription drug, oral, non chemotherapeutic, nos |
3,385 |
1,364 |
$2K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
16 |
15 |
$172.98 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
12 |
12 |
$145.70 |
| 64435 |
|
107 |
72 |
$31.72 |
| A4550 |
Surgical trays |
216 |
139 |
$10.28 |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
89 |
58 |
$0.00 |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
65 |
45 |
$0.00 |
| 88300 |
|
16 |
12 |
$0.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
46 |
45 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
113 |
112 |
$0.00 |
| S0191 |
Misoprostol, oral, 200 mcg |
355 |
216 |
$0.00 |
| S0190 |
Mifepristone, oral, 200 mg |
316 |
191 |
$0.00 |
| 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 |
131 |
100 |
$0.00 |
| 99152 |
|
89 |
58 |
$0.00 |
| 59841 |
|
261 |
166 |
$0.00 |