| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
159 |
133 |
$19K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
151 |
129 |
$13K |
| 76801 |
|
53 |
50 |
$7K |
| Q0091 |
Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory |
140 |
113 |
$5K |
| 99215 |
Prolong outpt/office vis |
26 |
24 |
$5K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
217 |
188 |
$4K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
50 |
24 |
$3K |
| 36415 |
Collection of venous blood by venipuncture |
584 |
505 |
$3K |
| 59025 |
Fetal non-stress test |
89 |
65 |
$2K |
| 76819 |
Fetal biophysical profile; without non-stress testing |
17 |
12 |
$2K |
| 76830 |
Ultrasound, transvaginal |
15 |
12 |
$2K |
| 90686 |
|
85 |
72 |
$1K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
18 |
14 |
$767.55 |
| 90715 |
|
27 |
25 |
$733.06 |
| 90674 |
|
20 |
19 |
$365.84 |
| 96127 |
|
23 |
19 |
$113.00 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
90 |
72 |
$38.85 |
| 82950 |
|
24 |
13 |
$23.75 |
| A4215 |
Needle, sterile, any size, each |
217 |
187 |
$0.00 |