| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
6,538 |
5,012 |
$437K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
8,453 |
6,584 |
$402K |
| H1000 |
Prenatal care, at-risk assessment |
207 |
159 |
$17K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
83 |
81 |
$5K |
| 76830 |
Ultrasound, transvaginal |
29 |
26 |
$2K |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
13 |
13 |
$852.29 |
| 90756 |
|
15 |
13 |
$238.16 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
16 |
13 |
$222.55 |
| 81025 |
|
14 |
13 |
$90.34 |
| 0502F |
|
606 |
406 |
$0.00 |