| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
361 |
320 |
$18K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
202 |
195 |
$14K |
| S0190 |
Mifepristone, oral, 200 mg |
65 |
65 |
$5K |
| 76856 |
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete |
73 |
70 |
$1K |
| 81025 |
|
310 |
295 |
$667.14 |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
18 |
18 |
$450.24 |
| S0191 |
Misoprostol, oral, 200 mcg |
83 |
79 |
$248.61 |
| 99051 |
|
14 |
14 |
$90.50 |
| 36415 |
Collection of venous blood by venipuncture |
16 |
14 |
$0.00 |