| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
490 |
434 |
$39K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
491 |
453 |
$26K |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
182 |
147 |
$7K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
53 |
52 |
$5K |
| 59025 |
Fetal non-stress test |
124 |
65 |
$4K |
| 81002 |
|
610 |
459 |
$2K |
| Q0091 |
Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory |
27 |
25 |
$167.85 |
| 0502F |
|
519 |
419 |
$0.00 |
| S9999 |
Sales tax |
266 |
237 |
$0.00 |