| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
901 |
803 |
$48K |
| 59400 |
Routine obstetric care including antepartum care, vaginal delivery, and postpartum care |
15 |
15 |
$30K |
| 76830 |
Ultrasound, transvaginal |
301 |
281 |
$15K |
| 59426 |
|
14 |
14 |
$5K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
48 |
48 |
$3K |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
37 |
36 |
$2K |
| 81002 |
|
814 |
765 |
$2K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
13 |
13 |
$1K |
| 36415 |
Collection of venous blood by venipuncture |
676 |
645 |
$833.75 |
| 59025 |
Fetal non-stress test |
24 |
12 |
$460.64 |
| Q0091 |
Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory |
12 |
12 |
$60.87 |
| 84703 |
|
13 |
13 |
$56.94 |
| A4558 |
Conductive gel or paste, for use with electrical device (e.g., tens, nmes), per oz |
63 |
55 |
$0.00 |