| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
11,469 |
9,502 |
$741K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
398 |
373 |
$29K |
| 59430 |
|
26 |
25 |
$6K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
25 |
25 |
$2K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
71 |
67 |
$2K |
| 76801 |
|
14 |
13 |
$1K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
17 |
13 |
$986.87 |
| 81025 |
|
139 |
129 |
$948.06 |
| 59025 |
Fetal non-stress test |
16 |
13 |
$558.37 |
| 90688 |
|
13 |
12 |
$169.48 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
14 |
13 |
$124.91 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
13 |
12 |
$65.25 |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
13 |
12 |
$0.00 |