| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 76819 |
Fetal biophysical profile; without non-stress testing |
609 |
249 |
$25K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
710 |
487 |
$22K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
230 |
181 |
$15K |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
317 |
183 |
$12K |
| 76856 |
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete |
203 |
128 |
$10K |
| 76801 |
|
238 |
131 |
$9K |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
221 |
113 |
$4K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
234 |
154 |
$4K |
| 81003 |
|
2,112 |
931 |
$3K |
| 90686 |
|
106 |
94 |
$2K |
| 76811 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, detailed |
16 |
15 |
$2K |
| 76820 |
|
23 |
19 |
$1K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
171 |
136 |
$1K |
| 87210 |
|
363 |
243 |
$995.22 |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
41 |
18 |
$835.91 |
| 81025 |
|
160 |
118 |
$766.00 |
| 90715 |
|
15 |
14 |
$632.46 |
| 0500F |
|
27 |
25 |
$110.00 |
| 0503F |
|
66 |
52 |
$70.00 |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
15 |
14 |
$34.75 |
| 3008F |
|
25 |
25 |
$20.00 |
| 3078F |
|
13 |
13 |
$10.00 |
| 3074F |
|
15 |
15 |
$10.00 |
| 0502F |
|
194 |
135 |
$0.00 |