| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
5,976 |
3,919 |
$210K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
57 |
57 |
$4K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
31 |
28 |
$2K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
15 |
12 |
$1K |
| 59025 |
Fetal non-stress test |
74 |
39 |
$894.72 |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
15 |
13 |
$852.28 |
| 81025 |
|
75 |
50 |
$299.47 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
13 |
12 |
$136.16 |
| 99459 |
|
17 |
15 |
$103.04 |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
15 |
13 |
$1.48 |
| 0502F |
|
76 |
56 |
$0.00 |