| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 0502F |
|
845 |
605 |
$37K |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
30 |
30 |
$2K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
35 |
35 |
$2K |
| 80081 |
|
31 |
28 |
$2K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
34 |
32 |
$2K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
34 |
32 |
$2K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
41 |
38 |
$1K |
| 0500F |
|
32 |
32 |
$1K |
| 87653 |
|
27 |
27 |
$1K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
17 |
17 |
$1K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
13 |
13 |
$934.70 |
| 87088 |
|
61 |
60 |
$689.91 |
| 59025 |
Fetal non-stress test |
34 |
27 |
$629.80 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
79 |
72 |
$447.72 |
| 82950 |
|
53 |
51 |
$246.98 |
| 87210 |
|
38 |
37 |
$178.60 |
| 87081 |
|
15 |
15 |
$87.00 |
| 36415 |
Collection of venous blood by venipuncture |
21 |
15 |
$0.00 |