| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
3,305 |
2,009 |
$256K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
3,862 |
3,756 |
$202K |
| 59400 |
Routine obstetric care including antepartum care, vaginal delivery, and postpartum care |
81 |
81 |
$170K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
897 |
897 |
$83K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
1,234 |
895 |
$68K |
| 76819 |
Fetal biophysical profile; without non-stress testing |
1,266 |
909 |
$63K |
| 76830 |
Ultrasound, transvaginal |
1,132 |
814 |
$62K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,740 |
1,672 |
$54K |
| 76818 |
|
493 |
205 |
$34K |
| 59025 |
Fetal non-stress test |
557 |
301 |
$25K |
| 76811 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, detailed |
158 |
122 |
$17K |
| 81002 |
|
5,662 |
3,703 |
$15K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
1,011 |
969 |
$13K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
100 |
100 |
$13K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
148 |
148 |
$11K |
| 90715 |
|
221 |
219 |
$9K |
| 81025 |
|
1,136 |
1,134 |
$8K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
68 |
68 |
$7K |
| 90658 |
|
302 |
302 |
$4K |
| 76801 |
|
56 |
43 |
$4K |
| A0429 |
Ambulance service, basic life support, emergency transport (bls-emergency) |
13 |
12 |
$3K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
150 |
150 |
$3K |
| 76856 |
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete |
40 |
27 |
$2K |
| A0425 |
Ground mileage, per statute mile |
16 |
15 |
$445.77 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
17 |
16 |
$255.68 |
| 76857 |
|
14 |
14 |
$212.63 |
| 83986 |
|
12 |
12 |
$32.70 |