| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
6,143 |
4,402 |
$381K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,099 |
1,849 |
$185K |
| 59025 |
Fetal non-stress test |
912 |
471 |
$31K |
| 81002 |
|
7,846 |
5,340 |
$25K |
| 81025 |
|
3,279 |
2,904 |
$25K |
| 76830 |
Ultrasound, transvaginal |
227 |
221 |
$20K |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
128 |
123 |
$11K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
72 |
71 |
$11K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
78 |
74 |
$8K |
| 93923 |
|
56 |
54 |
$7K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
79 |
72 |
$6K |
| H0002 |
Behavioral health screening to determine eligibility for admission to treatment program |
181 |
176 |
$4K |
| 95923 |
|
56 |
56 |
$3K |
| 95921 |
|
56 |
56 |
$2K |
| 93922 |
|
12 |
12 |
$948.51 |
| 87070 |
|
40 |
40 |
$342.57 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
13 |
13 |
$248.16 |
| A4550 |
Surgical trays |
29 |
26 |
$160.28 |