| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
894 |
612 |
$61K |
| 59400 |
Routine obstetric care including antepartum care, vaginal delivery, and postpartum care |
159 |
69 |
$54K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
1,683 |
945 |
$35K |
| 0002A |
|
592 |
488 |
$24K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
559 |
361 |
$22K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,188 |
661 |
$20K |
| 0001A |
|
672 |
530 |
$20K |
| 99401 |
|
1,290 |
756 |
$15K |
| 54150 |
|
208 |
89 |
$15K |
| 76801 |
|
195 |
140 |
$12K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
890 |
559 |
$10K |
| 81025 |
|
1,671 |
984 |
$6K |
| 36415 |
Collection of venous blood by venipuncture |
1,954 |
1,260 |
$3K |
| 59025 |
Fetal non-stress test |
36 |
27 |
$1K |
| 90686 |
|
145 |
115 |
$1K |
| 90674 |
|
173 |
86 |
$1K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
24 |
12 |
$632.92 |
| 90714 |
|
56 |
40 |
$425.12 |
| 99402 |
|
130 |
69 |
$358.33 |
| 90715 |
|
16 |
13 |
$316.80 |
| 87210 |
|
111 |
41 |
$158.78 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
29 |
20 |
$119.40 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
26 |
13 |
$99.90 |
| 82950 |
|
27 |
14 |
$61.02 |
| 80307 |
Drug test(s), presumptive, any number of drug classes; immunoassay |
19 |
13 |
$0.00 |
| 85027 |
|
20 |
12 |
$0.00 |
| 87661 |
Infectious agent detection by nucleic acid; Trichomonas vaginalis, amplified probe |
21 |
15 |
$0.00 |
| 81001 |
|
33 |
21 |
$0.00 |
| 87088 |
|
33 |
21 |
$0.00 |