| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
13,871 |
10,068 |
$655K |
| 99199 |
Unlisted special service, procedure or report |
72,014 |
41,293 |
$415K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
2,642 |
2,166 |
$262K |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
3,462 |
2,597 |
$215K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
2,255 |
1,799 |
$186K |
| 59400 |
Routine obstetric care including antepartum care, vaginal delivery, and postpartum care |
128 |
102 |
$151K |
| 76819 |
Fetal biophysical profile; without non-stress testing |
1,676 |
692 |
$101K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
6,823 |
5,279 |
$91K |
| 76801 |
|
946 |
764 |
$81K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
961 |
726 |
$67K |
| 76830 |
Ultrasound, transvaginal |
805 |
557 |
$41K |
| S0280 |
Medical home program, comprehensive care coordination and planning, initial plan |
712 |
617 |
$33K |
| S0281 |
Medical home program, comprehensive care coordination and planning, maintenance of plan |
191 |
158 |
$24K |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
324 |
271 |
$24K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
346 |
314 |
$13K |
| 76818 |
|
151 |
70 |
$12K |
| 87210 |
|
2,067 |
1,640 |
$8K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
103 |
73 |
$8K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
79 |
67 |
$4K |
| 59025 |
Fetal non-stress test |
85 |
69 |
$2K |
| 99282 |
Emergency department visit for the evaluation and management, low to moderate severity |
62 |
52 |
$2K |
| 76813 |
|
15 |
13 |
$2K |
| 59430 |
|
160 |
158 |
$1K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
16 |
13 |
$1K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
55 |
45 |
$1K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
80 |
61 |
$558.60 |
| 90686 |
|
17 |
14 |
$230.62 |
| 81025 |
|
22 |
17 |
$109.20 |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
1,084 |
921 |
$1.28 |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
43 |
43 |
$0.00 |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
43 |
43 |
$0.00 |
| 90656 |
|
16 |
16 |
$0.00 |