| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 0502F |
|
6,430 |
4,299 |
$340K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,675 |
2,063 |
$165K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,242 |
854 |
$137K |
| 76818 |
|
1,425 |
806 |
$96K |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
1,067 |
840 |
$74K |
| 76830 |
Ultrasound, transvaginal |
1,069 |
935 |
$70K |
| 76856 |
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete |
1,022 |
912 |
$61K |
| 59409 |
Vaginal delivery only (with or without episiotomy and/or forceps) |
23 |
23 |
$21K |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
315 |
243 |
$21K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
215 |
204 |
$18K |
| 96127 |
|
1,185 |
934 |
$17K |
| 59025 |
Fetal non-stress test |
527 |
369 |
$17K |
| 59430 |
|
31 |
25 |
$6K |
| 0503F |
|
66 |
54 |
$5K |
| 81003 |
|
2,180 |
1,631 |
$5K |
| 90686 |
|
143 |
111 |
$3K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
14 |
14 |
$1K |
| 90661 |
|
18 |
14 |
$574.35 |
| 90715 |
|
17 |
14 |
$560.06 |
| 81025 |
|
149 |
125 |
$382.51 |
| 82962 |
|
47 |
37 |
$79.04 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
14 |
13 |
$0.00 |