| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
4,099 |
3,452 |
$325K |
| 99215 |
Prolong outpt/office vis |
475 |
395 |
$52K |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
532 |
444 |
$42K |
| 59410 |
|
27 |
27 |
$20K |
| 81002 |
|
5,156 |
4,279 |
$14K |
| 76801 |
|
158 |
131 |
$13K |
| 99220 |
|
141 |
111 |
$12K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
94 |
83 |
$9K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
263 |
196 |
$9K |
| 76819 |
Fetal biophysical profile; without non-stress testing |
111 |
81 |
$8K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
388 |
330 |
$6K |
| S0281 |
Medical home program, comprehensive care coordination and planning, maintenance of plan |
28 |
26 |
$3K |
| S0280 |
Medical home program, comprehensive care coordination and planning, initial plan |
17 |
17 |
$850.00 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
71 |
58 |
$776.91 |
| 90674 |
|
13 |
12 |
$269.47 |
| 87210 |
|
30 |
27 |
$117.50 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
15 |
13 |
$93.10 |
| 81025 |
|
14 |
12 |
$78.00 |
| 82950 |
|
12 |
12 |
$70.32 |
| Q0091 |
Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory |
12 |
12 |
$0.00 |
| 99000 |
|
207 |
190 |
$0.00 |