| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
172 |
160 |
$12K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
243 |
220 |
$6K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
72 |
62 |
$2K |
| 87210 |
|
398 |
361 |
$2K |
| 76856 |
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete |
17 |
14 |
$965.12 |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
12 |
12 |
$695.57 |
| 81025 |
|
29 |
25 |
$154.49 |
| 36416 |
|
29 |
28 |
$56.01 |
| 85018 |
|
13 |
12 |
$30.18 |
| 81003 |
|
13 |
12 |
$21.05 |
| 0502F |
|
1,414 |
813 |
$0.00 |