| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99205 |
Prolong outpt/office vis |
837 |
704 |
$147K |
| 99215 |
Prolong outpt/office vis |
1,114 |
902 |
$147K |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
3,218 |
2,608 |
$143K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,181 |
999 |
$75K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
683 |
617 |
$64K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
651 |
572 |
$58K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
399 |
371 |
$57K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
412 |
342 |
$21K |
| 99401 |
|
3,966 |
3,305 |
$17K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
147 |
125 |
$8K |
| 76801 |
|
112 |
93 |
$7K |
| 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 |
1,793 |
893 |
$5K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
463 |
386 |
$5K |
| 81025 |
|
628 |
555 |
$3K |
| 85018 |
|
1,533 |
1,314 |
$2K |
| 86901 |
|
1,121 |
979 |
$2K |
| 76830 |
Ultrasound, transvaginal |
29 |
29 |
$2K |
| S0190 |
Mifepristone, oral, 200 mg |
2,823 |
1,544 |
$1K |
| 59841 |
|
2,125 |
1,232 |
$791.86 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
13 |
13 |
$742.08 |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
6,802 |
4,505 |
$348.30 |
| S0191 |
Misoprostol, oral, 200 mcg |
3,670 |
1,898 |
$322.88 |
| 99152 |
|
2,877 |
1,571 |
$89.80 |
| J8499 |
Prescription drug, oral, non chemotherapeutic, nos |
3,365 |
1,054 |
$44.68 |
| 99072 |
|
2,758 |
1,670 |
$15.00 |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
3,019 |
1,575 |
$3.60 |
| 99199 |
Unlisted special service, procedure or report |
934 |
662 |
$0.00 |
| A4550 |
Surgical trays |
41 |
41 |
$0.00 |
| 36416 |
|
999 |
756 |
$0.00 |
| 59840 |
|
932 |
442 |
$0.00 |
| 76998 |
|
107 |
98 |
$0.00 |
| 64435 |
|
17 |
17 |
$0.00 |
| 88300 |
|
40 |
40 |
$0.00 |
| 99402 |
|
16 |
13 |
$0.00 |
| J2060 |
Injection, lorazepam, 2 mg |
20 |
12 |
$0.00 |