| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 59426 |
|
2,173 |
1,131 |
$183K |
| 59425 |
|
1,441 |
1,091 |
$114K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,327 |
1,134 |
$101K |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
435 |
393 |
$29K |
| 81003 |
|
8,409 |
5,280 |
$12K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
86 |
67 |
$7K |
| 76819 |
Fetal biophysical profile; without non-stress testing |
86 |
48 |
$4K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
100 |
70 |
$4K |
| 99219 |
|
15 |
14 |
$1K |
| 90715 |
|
58 |
53 |
$1K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
123 |
111 |
$1K |
| 81025 |
|
144 |
126 |
$888.02 |
| 59025 |
Fetal non-stress test |
18 |
14 |
$363.90 |
| 59430 |
|
437 |
378 |
$270.82 |
| 82950 |
|
72 |
66 |
$248.67 |
| 87510 |
|
12 |
12 |
$240.60 |
| 87480 |
|
12 |
12 |
$240.60 |
| 87660 |
|
12 |
12 |
$240.60 |
| 90686 |
|
14 |
14 |
$209.33 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
18 |
12 |
$179.66 |
| 0503F |
|
386 |
330 |
$0.00 |