| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 59426 |
|
113 |
113 |
$107K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,562 |
1,460 |
$82K |
| 59409 |
Vaginal delivery only (with or without episiotomy and/or forceps) |
101 |
99 |
$72K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
650 |
650 |
$52K |
| 76830 |
Ultrasound, transvaginal |
654 |
636 |
$47K |
| 59430 |
|
194 |
194 |
$46K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
389 |
388 |
$35K |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
470 |
444 |
$32K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
353 |
347 |
$26K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
379 |
339 |
$22K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
215 |
214 |
$18K |
| 59025 |
Fetal non-stress test |
546 |
260 |
$16K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
156 |
156 |
$10K |
| 99459 |
|
680 |
676 |
$9K |
| 76856 |
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete |
182 |
182 |
$8K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
197 |
187 |
$6K |
| 77067 |
Screening mammography, bilateral, including computer-aided detection |
67 |
67 |
$6K |
| 99385 |
|
40 |
40 |
$4K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
33 |
33 |
$3K |
| 96127 |
|
1,167 |
1,157 |
$3K |
| 87210 |
|
618 |
383 |
$3K |
| 81025 |
|
440 |
429 |
$3K |
| 58300 |
|
42 |
42 |
$2K |
| 77063 |
Screening digital breast tomosynthesis, bilateral |
67 |
67 |
$2K |
| 58301 |
|
14 |
13 |
$943.38 |
| 81002 |
|
232 |
224 |
$643.43 |
| 76857 |
|
14 |
14 |
$362.04 |
| 90686 |
|
12 |
12 |
$265.63 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
14 |
14 |
$229.06 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
14 |
14 |
$97.11 |
| 36415 |
Collection of venous blood by venipuncture |
13 |
12 |
$74.91 |
| 83986 |
|
14 |
12 |
$33.76 |
| 96160 |
|
121 |
120 |
$18.33 |
| 0502F |
|
523 |
288 |
$0.00 |