| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
5,859 |
3,442 |
$769K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,902 |
1,824 |
$81K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,066 |
1,280 |
$47K |
| 59430 |
|
573 |
488 |
$31K |
| 76818 |
|
505 |
281 |
$25K |
| 59025 |
Fetal non-stress test |
728 |
398 |
$14K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
324 |
269 |
$13K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
172 |
151 |
$10K |
| 90746 |
|
294 |
260 |
$8K |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
175 |
149 |
$8K |
| 59409 |
Vaginal delivery only (with or without episiotomy and/or forceps) |
12 |
12 |
$6K |
| 90715 |
|
294 |
265 |
$5K |
| 81003 |
|
4,776 |
2,602 |
$4K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
68 |
59 |
$3K |
| 81025 |
|
628 |
542 |
$1K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
74 |
56 |
$1K |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
29 |
25 |
$1K |
| 90651 |
|
12 |
12 |
$651.39 |
| 90656 |
|
66 |
65 |
$576.51 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
816 |
721 |
$325.32 |
| 90686 |
|
22 |
22 |
$173.35 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
32 |
26 |
$100.51 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
13 |
13 |
$0.00 |
| 82962 |
|
95 |
83 |
$0.00 |