| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
384 |
318 |
$13K |
| 59025 |
Fetal non-stress test |
352 |
209 |
$7K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
86 |
63 |
$7K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
129 |
108 |
$5K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
83 |
72 |
$4K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
72 |
41 |
$4K |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
51 |
43 |
$2K |
| 0503F |
|
54 |
27 |
$905.00 |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
16 |
14 |
$875.64 |
| 0500F |
|
56 |
33 |
$570.13 |
| 90756 |
|
20 |
16 |
$273.42 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
26 |
20 |
$162.75 |
| 81002 |
|
1,214 |
677 |
$117.08 |
| 81025 |
|
19 |
14 |
$83.23 |
| 3514F |
|
56 |
33 |
$0.00 |
| 3292F |
|
56 |
33 |
$0.00 |
| 3512F |
|
56 |
33 |
$0.00 |
| 0502F |
|
1,168 |
635 |
$0.00 |
| 3293F |
|
60 |
33 |
$0.00 |
| 3511F |
|
56 |
33 |
$0.00 |
| 3513F |
|
56 |
33 |
$0.00 |