| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 0502F |
|
2,237 |
1,475 |
$96K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
551 |
488 |
$23K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
189 |
150 |
$12K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
134 |
112 |
$8K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
321 |
232 |
$3K |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
50 |
39 |
$2K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
78 |
59 |
$2K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
12 |
12 |
$1K |
| 81025 |
|
256 |
196 |
$885.84 |
| 59025 |
Fetal non-stress test |
120 |
85 |
$861.10 |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
13 |
12 |
$595.40 |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
13 |
12 |
$595.40 |
| 90686 |
|
24 |
16 |
$399.63 |
| 84703 |
|
32 |
27 |
$229.12 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
19 |
15 |
$0.00 |