| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 95165 |
Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy, multiple dose vials |
306 |
302 |
$219K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,202 |
1,099 |
$87K |
| 95004 |
Percutaneous tests with allergenic extracts, immediate type reaction |
296 |
290 |
$69K |
| 76830 |
Ultrasound, transvaginal |
627 |
618 |
$67K |
| 76856 |
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete |
633 |
623 |
$60K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,103 |
1,035 |
$46K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
571 |
565 |
$44K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
234 |
233 |
$35K |
| 99386 |
|
316 |
313 |
$27K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
254 |
240 |
$14K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
101 |
101 |
$10K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
142 |
127 |
$8K |
| 99385 |
|
84 |
84 |
$7K |
| G0101 |
Cervical or vaginal cancer screening; pelvic and clinical breast examination |
359 |
354 |
$5K |
| 99401 |
|
213 |
204 |
$5K |
| Q0091 |
Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory |
301 |
298 |
$4K |
| 93976 |
|
28 |
27 |
$3K |
| 81002 |
|
723 |
717 |
$1K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
55 |
55 |
$1K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
54 |
54 |
$1K |
| 81025 |
|
179 |
176 |
$1K |
| 76700 |
Ultrasound, abdominal, real time with image documentation; complete |
12 |
12 |
$908.13 |
| 88150 |
|
105 |
105 |
$891.56 |
| 87070 |
|
121 |
119 |
$722.08 |
| 83986 |
|
143 |
142 |
$474.95 |
| 57150 |
|
12 |
12 |
$339.04 |
| 36415 |
Collection of venous blood by venipuncture |
261 |
260 |
$208.25 |
| 99080 |
|
169 |
18 |
$0.00 |