| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| H1001 |
Prenatal care, at-risk enhanced service; antepartum management |
443 |
375 |
$35K |
| 59425 |
|
257 |
216 |
$18K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
154 |
145 |
$5K |
| 59840 |
|
16 |
12 |
$5K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
80 |
71 |
$4K |
| Q0144 |
Azithromycin dihydrate, oral, capsules/powder, 1 gram |
298 |
289 |
$2K |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
318 |
308 |
$2K |
| 81003 |
|
869 |
750 |
$2K |
| 81025 |
|
153 |
146 |
$421.20 |
| 85018 |
|
12 |
12 |
$28.85 |