| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 76856 |
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete |
6,146 |
6,136 |
$391K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
19,489 |
17,751 |
$388K |
| 76830 |
Ultrasound, transvaginal |
5,865 |
5,856 |
$175K |
| 99223 |
Prolong inpt eval add15 m |
575 |
570 |
$157K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
3,367 |
3,343 |
$144K |
| Z1034 |
|
2,452 |
1,756 |
$140K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
937 |
934 |
$41K |
| 58100 |
|
1,289 |
700 |
$33K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,311 |
1,272 |
$30K |
| 88141 |
|
7,928 |
7,831 |
$29K |
| 57454 |
|
474 |
290 |
$22K |
| 59430 |
|
301 |
296 |
$16K |
| 99386 |
|
510 |
507 |
$16K |
| 59400 |
Routine obstetric care including antepartum care, vaginal delivery, and postpartum care |
24 |
24 |
$13K |
| 99232 |
Subsequent hospital care, per day, moderate complexity |
606 |
396 |
$12K |
| 99238 |
Hospital discharge day management, 30 minutes or less |
609 |
606 |
$12K |
| 76801 |
|
94 |
93 |
$7K |
| Z1032 |
|
45 |
45 |
$5K |
| 59514 |
|
13 |
13 |
$4K |
| 99385 |
|
123 |
122 |
$4K |
| 81025 |
|
3,252 |
3,178 |
$3K |
| 90651 |
|
12 |
12 |
$2K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
55 |
54 |
$2K |
| 57511 |
|
47 |
24 |
$2K |
| 99000 |
|
7,094 |
7,001 |
$1K |
| H1001 |
Prenatal care, at-risk enhanced service; antepartum management |
18 |
13 |
$905.28 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
28 |
28 |
$168.00 |
| 57410 |
|
13 |
13 |
$75.00 |
| A4550 |
Surgical trays |
229 |
225 |
$45.00 |
| Q0091 |
Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory |
12 |
12 |
$45.00 |
| 0503F |
|
266 |
263 |
$15.00 |
| G0101 |
Cervical or vaginal cancer screening; pelvic and clinical breast examination |
25 |
25 |
$0.00 |