| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
4,231 |
3,256 |
$463K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,689 |
1,929 |
$321K |
| S0612 |
Annual gynecological examination, established patient |
260 |
260 |
$29K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
218 |
192 |
$23K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
564 |
555 |
$14K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
109 |
73 |
$12K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
80 |
73 |
$9K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
64 |
47 |
$9K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
61 |
44 |
$7K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
59 |
38 |
$6K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
44 |
33 |
$5K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
36 |
28 |
$5K |
| 99215 |
Prolong outpt/office vis |
32 |
25 |
$5K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
42 |
31 |
$5K |
| 76830 |
Ultrasound, transvaginal |
80 |
80 |
$5K |
| 96127 |
|
430 |
426 |
$3K |
| 0072A |
|
15 |
15 |
$600.00 |
| 76856 |
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete |
14 |
14 |
$493.94 |
| 0071A |
|
12 |
12 |
$480.00 |
| 80305 |
|
53 |
46 |
$262.60 |
| 81003 |
|
54 |
54 |
$100.22 |
| 90686 |
|
24 |
24 |
$23.53 |