| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 0502F |
|
1,677 |
1,119 |
$102K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
923 |
778 |
$63K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
654 |
571 |
$57K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
235 |
159 |
$16K |
| 59025 |
Fetal non-stress test |
395 |
226 |
$9K |
| 96127 |
|
206 |
184 |
$3K |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
29 |
29 |
$1K |
| 81025 |
|
171 |
140 |
$847.16 |
| H1000 |
Prenatal care, at-risk assessment |
42 |
32 |
$619.36 |
| 90656 |
|
29 |
24 |
$612.20 |
| 90686 |
|
13 |
13 |
$285.61 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
27 |
18 |
$0.00 |