| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
4,111 |
3,448 |
$262K |
| 59426 |
|
158 |
157 |
$135K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
994 |
948 |
$4K |
| 59430 |
|
105 |
105 |
$3K |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
154 |
140 |
$3K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
412 |
408 |
$2K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
267 |
253 |
$725.44 |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
36 |
36 |
$723.08 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
360 |
334 |
$500.40 |
| 59025 |
Fetal non-stress test |
98 |
37 |
$461.38 |
| 81025 |
|
416 |
403 |
$410.91 |
| 90686 |
|
107 |
104 |
$384.45 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
229 |
222 |
$202.52 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
32 |
32 |
$89.89 |
| 90715 |
|
12 |
12 |
$61.80 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
15 |
15 |
$60.42 |
| 36415 |
Collection of venous blood by venipuncture |
61 |
51 |
$37.80 |
| 81003 |
|
17 |
17 |
$3.74 |