| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
174 |
155 |
$12K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
162 |
122 |
$6K |
| 59025 |
Fetal non-stress test |
91 |
45 |
$3K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
36 |
25 |
$2K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
15 |
15 |
$2K |
| 76830 |
Ultrasound, transvaginal |
15 |
13 |
$2K |
| Q0091 |
Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory |
92 |
59 |
$400.20 |
| 0503F |
|
12 |
12 |
$0.00 |