| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
21,280 |
14,982 |
$2.65M |
| 99199 |
Unlisted special service, procedure or report |
30,916 |
12,382 |
$249K |
| 59409 |
Vaginal delivery only (with or without episiotomy and/or forceps) |
107 |
73 |
$44K |
| 81025 |
|
4,765 |
3,911 |
$31K |
| 81003 |
|
11,008 |
7,132 |
$30K |
| S0281 |
Medical home program, comprehensive care coordination and planning, maintenance of plan |
113 |
111 |
$16K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
211 |
200 |
$14K |
| S0280 |
Medical home program, comprehensive care coordination and planning, initial plan |
284 |
276 |
$12K |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
240 |
222 |
$12K |
| 59025 |
Fetal non-stress test |
669 |
425 |
$11K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,710 |
2,032 |
$4K |
| 76830 |
Ultrasound, transvaginal |
52 |
40 |
$2K |
| 85018 |
|
686 |
590 |
$2K |
| 87210 |
|
465 |
386 |
$1K |
| 76801 |
|
12 |
12 |
$776.40 |
| 99219 |
|
46 |
37 |
$766.24 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
26 |
24 |
$146.94 |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
13 |
12 |
$124.72 |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
13 |
12 |
$124.72 |
| 3074F |
|
1,638 |
1,369 |
$0.01 |
| 3008F |
|
190 |
163 |
$0.01 |
| 3078F |
|
1,092 |
922 |
$0.01 |
| 3079F |
|
316 |
263 |
$0.00 |