| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
2,908 |
2,598 |
$756K |
| J7301 |
Levonorgestrel-releasing intrauterine contraceptive system (skyla), 13.5 mg |
500 |
454 |
$577K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
4,174 |
3,337 |
$369K |
| H1001 |
Prenatal care, at-risk enhanced service; antepartum management |
5,801 |
2,739 |
$308K |
| Z1034 |
|
4,358 |
2,536 |
$243K |
| 76811 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, detailed |
2,071 |
2,052 |
$243K |
| 58300 |
|
1,403 |
731 |
$232K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
5,052 |
4,147 |
$216K |
| J7298 |
Levonorgestrel-releasing intrauterine contraceptive system (mirena), 52 mg |
165 |
113 |
$147K |
| S9445 |
Patient education, not otherwise classified, non-physician provider, individual, per session |
8,128 |
5,168 |
$107K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
950 |
799 |
$103K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
2,101 |
2,096 |
$86K |
| 36410 |
|
8,227 |
5,316 |
$77K |
| 97803 |
|
5,621 |
2,578 |
$76K |
| H1003 |
Prenatal care, at-risk enhanced service; education |
6,823 |
3,497 |
$67K |
| Z1032 |
|
373 |
373 |
$59K |
| Z6500 |
|
307 |
307 |
$38K |
| 59425 |
|
1,477 |
803 |
$38K |
| 96156 |
|
2,100 |
1,005 |
$33K |
| Z6410 |
|
4,011 |
2,270 |
$31K |
| Z6400 |
|
3,040 |
2,299 |
$25K |
| 81025 |
|
5,186 |
4,999 |
$23K |
| J7307 |
Etonogestrel (contraceptive) implant system, including implant and supplies |
13 |
12 |
$23K |
| H1000 |
Prenatal care, at-risk assessment |
153 |
150 |
$19K |
| 99401 |
|
1,074 |
805 |
$16K |
| 87811 |
Infectious agent antigen detection by immunoassay; SARS-CoV-2 (COVID-19) |
564 |
508 |
$16K |
| 99000 |
|
3,782 |
3,701 |
$13K |
| H1002 |
Prenatal care, at risk enhanced service; care coordination |
522 |
388 |
$12K |
| 11981 |
|
26 |
12 |
$11K |
| 88150 |
|
1,442 |
1,423 |
$10K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
191 |
186 |
$10K |
| Z6204 |
|
1,131 |
762 |
$9K |
| 99215 |
Prolong outpt/office vis |
122 |
121 |
$6K |
| H2000 |
Comprehensive multidisciplinary evaluation |
87 |
85 |
$5K |
| 81003 |
|
2,626 |
1,232 |
$5K |
| Z6406 |
|
526 |
404 |
$4K |
| 96151 |
|
605 |
304 |
$2K |
| 59514 |
|
15 |
15 |
$2K |
| 59430 |
|
24 |
24 |
$1K |
| 57454 |
|
23 |
12 |
$975.90 |
| 76856 |
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete |
13 |
13 |
$737.96 |
| 76830 |
Ultrasound, transvaginal |
12 |
12 |
$721.77 |
| 58301 |
|
24 |
12 |
$703.68 |
| 81000 |
|
12 |
12 |
$299.53 |
| Z6304 |
|
25 |
25 |
$190.01 |
| Q0111 |
Wet mounts, including preparations of vaginal, cervical or skin specimens |
44 |
44 |
$160.67 |
| S9452 |
Nutrition classes, non-physician provider, per session |
12 |
12 |
$136.62 |
| 88141 |
|
25 |
25 |
$99.93 |
| 82950 |
|
25 |
24 |
$95.77 |
| 82962 |
|
13 |
13 |
$4.80 |
| 0502F |
|
97 |
69 |
$0.00 |