| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,209 |
1,942 |
$108K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,052 |
952 |
$32K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
330 |
320 |
$25K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
63 |
61 |
$5K |
| 90688 |
|
225 |
220 |
$4K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
250 |
245 |
$3K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
32 |
28 |
$3K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
127 |
70 |
$2K |
| 81025 |
|
186 |
176 |
$1K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
14 |
14 |
$1K |
| 0124A |
|
29 |
28 |
$996.36 |
| 0003A |
|
16 |
15 |
$448.06 |
| S9999 |
Sales tax |
683 |
512 |
$10.09 |
| 91300 |
|
48 |
44 |
$0.00 |
| 91312 |
|
30 |
30 |
$0.00 |