| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 59025 |
Fetal non-stress test |
1,965 |
1,458 |
$80K |
| 76801 |
|
453 |
440 |
$33K |
| 59425 |
|
54 |
53 |
$23K |
| 59426 |
|
14 |
14 |
$11K |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
59 |
56 |
$4K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
256 |
253 |
$3K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
39 |
39 |
$3K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
43 |
38 |
$2K |
| 90715 |
|
49 |
49 |
$2K |
| 90674 |
|
54 |
54 |
$1K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
26 |
26 |
$719.75 |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
13 |
13 |
$682.14 |
| 81025 |
|
26 |
25 |
$143.89 |
| A4550 |
Surgical trays |
27 |
27 |
$0.00 |