| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| 90674 |
|
13 |
13 |
$281.30 |
| 81003 |
|
133 |
116 |
$269.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
78 |
61 |
$219.36 |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
115 |
82 |
$171.80 |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
210 |
188 |
$144.13 |
| 81025 |
|
27 |
24 |
$65.18 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
16 |
16 |
$55.00 |
| 59425 |
|
39 |
33 |
$0.00 |
| 59409 |
Vaginal delivery only (with or without episiotomy and/or forceps) |
41 |
38 |
$0.00 |
| 3078F |
|
25 |
25 |
$0.00 |
| 59426 |
|
127 |
110 |
$0.00 |
| 76801 |
|
93 |
84 |
$0.00 |
| 81000 |
|
275 |
248 |
$0.00 |
| 59400 |
Routine obstetric care including antepartum care, vaginal delivery, and postpartum care |
26 |
25 |
$0.00 |
| 3074F |
|
12 |
12 |
$0.00 |