| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
4,105 |
3,187 |
$131K |
| 59025 |
Fetal non-stress test |
1,669 |
811 |
$42K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
832 |
681 |
$19K |
| Q0091 |
Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory |
584 |
462 |
$15K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
122 |
106 |
$9K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
82 |
77 |
$8K |
| 76801 |
|
107 |
100 |
$7K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
67 |
65 |
$7K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
117 |
101 |
$7K |
| 81025 |
|
828 |
697 |
$5K |
| 99401 |
|
227 |
137 |
$4K |
| 59430 |
|
162 |
131 |
$4K |
| 0500F |
|
304 |
253 |
$3K |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
33 |
24 |
$2K |
| 0503F |
|
284 |
202 |
$2K |
| 90674 |
|
38 |
34 |
$757.47 |
| 90756 |
|
28 |
27 |
$523.74 |
| 81003 |
|
212 |
137 |
$428.82 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
99 |
88 |
$300.40 |
| 0502F |
|
5,857 |
3,600 |
$0.00 |
| 0501F |
|
301 |
251 |
$0.00 |