| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
155 |
151 |
$74K |
| J3490 |
Unclassified drugs |
1,530 |
1,381 |
$56K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,237 |
1,108 |
$32K |
| 87806 |
|
1,177 |
1,170 |
$30K |
| A4267 |
Contraceptive supply, condom, male, each |
784 |
752 |
$13K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
247 |
211 |
$11K |
| 81025 |
|
2,750 |
2,428 |
$7K |
| S4993 |
Contraceptive pills for birth control |
54 |
51 |
$7K |
| S0190 |
Mifepristone, oral, 200 mg |
111 |
107 |
$7K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
195 |
156 |
$7K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
126 |
83 |
$6K |
| Q0144 |
Azithromycin dihydrate, oral, capsules/powder, 1 gram |
251 |
225 |
$5K |
| 99000 |
|
600 |
599 |
$3K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
40 |
40 |
$2K |
| 87481 |
|
54 |
49 |
$1K |
| 87661 |
Infectious agent detection by nucleic acid; Trichomonas vaginalis, amplified probe |
54 |
49 |
$1K |
| 87799 |
|
55 |
49 |
$894.83 |
| S0191 |
Misoprostol, oral, 200 mcg |
87 |
83 |
$843.19 |
| 99201 |
|
24 |
24 |
$735.44 |
| 86592 |
|
159 |
158 |
$575.00 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
32 |
24 |
$437.80 |
| 85018 |
|
88 |
85 |
$146.97 |
| G9920 |
Screening performed and negative |
14 |
14 |
$145.00 |
| 86901 |
|
14 |
14 |
$34.44 |