| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
7,611 |
4,789 |
$444K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
1,023 |
671 |
$74K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,614 |
1,296 |
$67K |
| Q0091 |
Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory |
1,793 |
1,080 |
$25K |
| 81025 |
|
2,180 |
1,482 |
$10K |
| 99459 |
|
548 |
504 |
$9K |
| 3008F |
|
8,058 |
4,978 |
$9K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
83 |
54 |
$8K |
| 99385 |
|
76 |
33 |
$6K |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
109 |
100 |
$4K |
| 0500F |
|
219 |
87 |
$3K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
36 |
27 |
$2K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
154 |
99 |
$949.21 |
| 0503F |
|
38 |
27 |
$833.74 |
| 59025 |
Fetal non-stress test |
36 |
25 |
$764.36 |
| 90658 |
|
92 |
55 |
$723.01 |
| 76830 |
Ultrasound, transvaginal |
14 |
13 |
$676.28 |
| 76819 |
Fetal biophysical profile; without non-stress testing |
16 |
12 |
$616.92 |
| 0501F |
|
163 |
117 |
$130.00 |