| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| H1000 |
Prenatal care, at-risk assessment |
15,084 |
8,669 |
$1.04M |
| 59410 |
|
766 |
665 |
$753K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
12,101 |
10,047 |
$713K |
| 76830 |
Ultrasound, transvaginal |
2,482 |
2,320 |
$418K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
3,343 |
3,198 |
$404K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
4,437 |
4,028 |
$337K |
| 59430 |
|
1,698 |
1,345 |
$296K |
| H1001 |
Prenatal care, at-risk enhanced service; antepartum management |
1,842 |
1,696 |
$295K |
| 59515 |
|
210 |
183 |
$238K |
| 76856 |
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete |
4,008 |
3,786 |
$207K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
1,868 |
1,774 |
$198K |
| 99385 |
|
1,294 |
1,240 |
$159K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
956 |
934 |
$115K |
| 99386 |
|
559 |
535 |
$78K |
| 93975 |
|
566 |
529 |
$74K |
| J7297 |
Levonorgestrel-releasing intrauterine contraceptive system (liletta), 52 mg |
47 |
43 |
$43K |
| 99238 |
Hospital discharge day management, 30 minutes or less |
656 |
610 |
$43K |
| 76818 |
|
273 |
203 |
$36K |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
595 |
512 |
$26K |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
312 |
270 |
$20K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
222 |
213 |
$18K |
| 99232 |
Subsequent hospital care, per day, moderate complexity |
91 |
83 |
$16K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
1,033 |
1,012 |
$13K |
| 57454 |
|
57 |
55 |
$10K |
| 58300 |
|
138 |
124 |
$10K |
| 76998 |
|
78 |
60 |
$10K |
| 99218 |
|
139 |
109 |
$9K |
| 76819 |
Fetal biophysical profile; without non-stress testing |
66 |
58 |
$8K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
86 |
80 |
$7K |
| 58100 |
|
45 |
44 |
$6K |
| 99231 |
Subsequent hospital care, per day, straightforward or low complexity |
571 |
544 |
$6K |
| 59025 |
Fetal non-stress test |
59 |
42 |
$4K |
| 99284 |
Emergency department visit for the evaluation and management, high severity |
51 |
40 |
$3K |
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
17 |
15 |
$1K |
| 99442 |
|
22 |
13 |
$276.96 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
15 |
14 |
$66.84 |
| Q0091 |
Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory |
38 |
30 |
$44.27 |
| 96160 |
|
26 |
22 |
$10.60 |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
89 |
86 |
$0.58 |
| 0503F |
|
45 |
36 |
$0.00 |
| G0101 |
Cervical or vaginal cancer screening; pelvic and clinical breast examination |
16 |
13 |
$0.00 |