| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
140 |
123 |
$7K |
| 59425 |
|
20 |
19 |
$5K |
| 0503F |
|
74 |
53 |
$1K |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
22 |
14 |
$1K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
37 |
36 |
$1K |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
15 |
15 |
$550.02 |
| 0500F |
|
84 |
63 |
$295.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
30 |
25 |
$166.72 |
| 0502F |
|
86 |
71 |
$160.00 |
| 0501F |
|
52 |
40 |
$140.00 |