| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J7301 |
Levonorgestrel-releasing intrauterine contraceptive system (skyla), 13.5 mg |
534 |
423 |
$398K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
891 |
831 |
$253K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,753 |
1,610 |
$222K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,469 |
1,261 |
$136K |
| Z1034 |
|
1,492 |
1,374 |
$81K |
| 58300 |
|
419 |
412 |
$68K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
367 |
310 |
$60K |
| 76830 |
Ultrasound, transvaginal |
874 |
855 |
$57K |
| J3490 |
Unclassified drugs |
289 |
264 |
$32K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
121 |
120 |
$25K |
| S9445 |
Patient education, not otherwise classified, non-physician provider, individual, per session |
1,630 |
1,630 |
$21K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
58 |
56 |
$20K |
| Z1032 |
|
132 |
132 |
$15K |
| 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 |
39 |
39 |
$9K |
| S0190 |
Mifepristone, oral, 200 mg |
76 |
65 |
$3K |
| 81025 |
|
926 |
919 |
$3K |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
36 |
36 |
$2K |
| S0191 |
Misoprostol, oral, 200 mcg |
40 |
36 |
$48.00 |