| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
234 |
212 |
$16K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
209 |
193 |
$10K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
111 |
108 |
$8K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
67 |
63 |
$5K |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
53 |
53 |
$4K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
36 |
36 |
$1K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
12 |
12 |
$740.89 |
| 85027 |
|
12 |
12 |
$619.41 |
| 86901 |
|
12 |
12 |
$251.84 |
| 86900 |
|
12 |
12 |
$251.84 |
| 36415 |
Collection of venous blood by venipuncture |
18 |
14 |
$235.18 |
| 59025 |
Fetal non-stress test |
14 |
13 |
$158.89 |