| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,590 |
1,138 |
$65K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
607 |
445 |
$39K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
130 |
126 |
$11K |
| 59430 |
|
200 |
179 |
$10K |
| 59409 |
Vaginal delivery only (with or without episiotomy and/or forceps) |
15 |
15 |
$9K |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
175 |
138 |
$8K |
| 76819 |
Fetal biophysical profile; without non-stress testing |
126 |
89 |
$7K |
| 99205 |
Prolong outpt/office vis |
13 |
13 |
$2K |
| 54150 |
|
14 |
13 |
$2K |
| H0049 |
Alcohol and/or drug screening |
90 |
86 |
$1K |
| 81025 |
|
55 |
54 |
$328.12 |
| 90686 |
|
15 |
15 |
$261.95 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
15 |
15 |
$220.50 |
| 0503F |
|
238 |
179 |
$0.00 |