| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,042 |
608 |
$50K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
162 |
148 |
$15K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
120 |
94 |
$7K |
| S0281 |
Medical home program, comprehensive care coordination and planning, maintenance of plan |
14 |
14 |
$2K |
| 76801 |
|
14 |
13 |
$1K |
| 90674 |
|
48 |
38 |
$695.64 |
| 81025 |
|
75 |
60 |
$420.81 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
46 |
38 |
$366.25 |
| 36415 |
Collection of venous blood by venipuncture |
165 |
142 |
$364.50 |
| 59025 |
Fetal non-stress test |
23 |
12 |
$232.80 |
| 99000 |
|
20 |
17 |
$0.00 |