| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
209 |
205 |
$29K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
490 |
287 |
$24K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
208 |
204 |
$23K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
110 |
61 |
$8K |
| 88175 |
Cytopathology, cervical or vaginal, any reporting system; collected in preservative fluid, automated thin layer |
81 |
81 |
$6K |
| 87624 |
Infectious agent detection by nucleic acid; human papillomavirus (HPV), high-risk types |
12 |
12 |
$2K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
24 |
24 |
$2K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
53 |
44 |
$1K |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
13 |
12 |
$1K |
| 87480 |
|
12 |
12 |
$866.99 |
| 87660 |
|
12 |
12 |
$798.93 |
| 81025 |
|
47 |
40 |
$266.02 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
15 |
14 |
$164.55 |
| 3078F |
|
1,639 |
598 |
$2.76 |
| 1036F |
|
774 |
301 |
$1.14 |
| 4004F |
|
83 |
66 |
$0.41 |
| 3074F |
|
1,659 |
470 |
$0.17 |
| 3079F |
|
38 |
12 |
$0.02 |