| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
199 |
130 |
$18K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
206 |
140 |
$7K |
| S9088 |
Services provided in an urgent care center (list in addition to code for service) |
493 |
357 |
$6K |
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
156 |
152 |
$5K |
| 99285 |
Emergency department visit for the evaluation and management, high severity with immediate threat to life |
22 |
22 |
$3K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
212 |
188 |
$829.52 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
45 |
29 |
$762.15 |
| 90461 |
|
108 |
101 |
$708.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
27 |
14 |
$611.94 |
| 90651 |
|
36 |
33 |
$0.30 |
| 90670 |
|
36 |
34 |
$0.29 |
| 90621 |
|
15 |
15 |
$0.15 |
| 90656 |
|
19 |
17 |
$0.14 |
| 90734 |
|
16 |
14 |
$0.12 |
| 99051 |
|
16 |
16 |
$0.00 |