| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 59425 |
|
3,630 |
2,048 |
$217K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
4,101 |
3,868 |
$106K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,570 |
1,500 |
$37K |
| 99215 |
Prolong outpt/office vis |
229 |
229 |
$29K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
421 |
421 |
$23K |
| 76856 |
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete |
327 |
325 |
$21K |
| 81002 |
|
9,185 |
5,781 |
$20K |
| 76811 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, detailed |
120 |
118 |
$19K |
| G0101 |
Cervical or vaginal cancer screening; pelvic and clinical breast examination |
1,268 |
1,268 |
$7K |
| 59409 |
Vaginal delivery only (with or without episiotomy and/or forceps) |
12 |
12 |
$6K |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
276 |
90 |
$6K |
| 81025 |
|
1,198 |
1,169 |
$3K |
| 76801 |
|
39 |
38 |
$3K |
| Z1034 |
|
44 |
27 |
$2K |
| 99238 |
Hospital discharge day management, 30 minutes or less |
53 |
52 |
$2K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
17 |
16 |
$1K |
| 90674 |
|
36 |
36 |
$1K |
| 90686 |
|
47 |
47 |
$969.79 |
| 59025 |
Fetal non-stress test |
99 |
29 |
$818.37 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
72 |
72 |
$413.06 |
| 99000 |
|
38 |
38 |
$118.99 |
| 3015F |
|
38 |
38 |
$0.00 |
| A4550 |
Surgical trays |
39 |
37 |
$0.00 |