| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
1,384 |
1,380 |
$112K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,521 |
2,374 |
$112K |
| 59426 |
|
95 |
95 |
$85K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
874 |
852 |
$62K |
| 59430 |
|
164 |
162 |
$37K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
238 |
238 |
$22K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
200 |
197 |
$19K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
253 |
252 |
$16K |
| 59409 |
Vaginal delivery only (with or without episiotomy and/or forceps) |
13 |
13 |
$10K |
| 81025 |
|
1,312 |
1,284 |
$9K |
| 76830 |
Ultrasound, transvaginal |
104 |
104 |
$7K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
81 |
77 |
$4K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
399 |
388 |
$3K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
164 |
157 |
$2K |
| Q0091 |
Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory |
120 |
120 |
$2K |
| 87210 |
|
229 |
225 |
$864.77 |
| 90715 |
|
24 |
24 |
$856.44 |
| 90656 |
|
24 |
24 |
$495.40 |
| 90686 |
|
12 |
12 |
$235.01 |
| 81002 |
|
39 |
39 |
$109.60 |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
224 |
221 |
$85.12 |
| 3008F |
|
1,534 |
1,526 |
$0.00 |
| 3079F |
|
369 |
369 |
$0.00 |
| 3074F |
|
1,208 |
1,200 |
$0.00 |
| 1036F |
|
1,576 |
1,559 |
$0.00 |
| 0501F |
|
30 |
30 |
$0.00 |
| 3075F |
|
16 |
16 |
$0.00 |
| 99024 |
|
13 |
12 |
$0.00 |
| 3078F |
|
853 |
847 |
$0.00 |
| 3725F |
|
1,337 |
1,336 |
$0.00 |
| 1160F |
|
1,070 |
1,064 |
$0.00 |
| 0502F |
|
765 |
597 |
$0.00 |
| 1159F |
|
1,061 |
1,056 |
$0.00 |