| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,692 |
2,514 |
$204K |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
889 |
737 |
$85K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
713 |
608 |
$64K |
| 76830 |
Ultrasound, transvaginal |
655 |
640 |
$36K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
275 |
273 |
$35K |
| 59425 |
|
35 |
35 |
$18K |
| 59426 |
|
17 |
17 |
$17K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
109 |
103 |
$13K |
| 54150 |
|
24 |
24 |
$3K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
24 |
24 |
$2K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
16 |
16 |
$2K |
| 59025 |
Fetal non-stress test |
17 |
14 |
$734.08 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
27 |
26 |
$608.58 |
| 90674 |
|
12 |
12 |
$300.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
13 |
12 |
$65.00 |