| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 59400 |
Routine obstetric care including antepartum care, vaginal delivery, and postpartum care |
1,594 |
1,277 |
$1.75M |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
11,653 |
8,765 |
$817K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
12,277 |
4,910 |
$773K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
15,828 |
10,692 |
$692K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
5,314 |
4,429 |
$515K |
| 59025 |
Fetal non-stress test |
20,818 |
9,939 |
$476K |
| S0281 |
Medical home program, comprehensive care coordination and planning, maintenance of plan |
3,862 |
2,871 |
$423K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
5,091 |
3,710 |
$327K |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
5,468 |
3,056 |
$310K |
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
8,915 |
6,381 |
$306K |
| 99215 |
Prolong outpt/office vis |
2,977 |
2,250 |
$269K |
| 59410 |
|
327 |
261 |
$216K |
| 59510 |
|
194 |
127 |
$169K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
3,484 |
2,372 |
$151K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
2,041 |
1,399 |
$145K |
| S0280 |
Medical home program, comprehensive care coordination and planning, initial plan |
5,460 |
4,508 |
$140K |
| 76830 |
Ultrasound, transvaginal |
2,453 |
1,882 |
$117K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
2,336 |
1,710 |
$106K |
| 76813 |
|
1,182 |
995 |
$87K |
| J7307 |
Etonogestrel (contraceptive) implant system, including implant and supplies |
133 |
85 |
$86K |
| 76801 |
|
708 |
605 |
$62K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
5,336 |
3,336 |
$53K |
| 81025 |
|
10,583 |
7,257 |
$52K |
| 90715 |
|
1,693 |
1,172 |
$47K |
| 85018 |
|
18,546 |
13,264 |
$35K |
| 82950 |
|
4,658 |
3,258 |
$17K |
| 82951 |
|
1,552 |
1,142 |
$17K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
2,068 |
1,451 |
$13K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
117 |
101 |
$8K |
| J7297 |
Levonorgestrel-releasing intrauterine contraceptive system (liletta), 52 mg |
15 |
12 |
$7K |
| 81002 |
|
4,379 |
3,157 |
$7K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
363 |
324 |
$7K |
| 87210 |
|
1,560 |
1,107 |
$4K |
| 11981 |
|
58 |
39 |
$4K |
| J2790 |
Injection, rho d immune globulin, human, full dose, 300 micrograms (1500 i.u.) |
53 |
45 |
$4K |
| 90674 |
|
158 |
111 |
$3K |
| 82962 |
|
1,582 |
989 |
$3K |
| 58300 |
|
66 |
52 |
$3K |
| 99385 |
|
51 |
27 |
$3K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
86 |
57 |
$2K |
| 90686 |
|
120 |
104 |
$1K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
42 |
13 |
$1K |
| 58301 |
|
23 |
12 |
$838.75 |
| 99459 |
|
63 |
56 |
$610.18 |
| 82947 |
|
136 |
120 |
$570.62 |
| J3490 |
Unclassified drugs |
28 |
12 |
$19.80 |
| 0502F |
|
64 |
45 |
$0.00 |