| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| H1000 |
Prenatal care, at-risk assessment |
7,674 |
5,572 |
$1.06M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
3,952 |
3,533 |
$198K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
317 |
313 |
$29K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
655 |
613 |
$27K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
197 |
195 |
$18K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
814 |
785 |
$15K |
| 99381 |
|
106 |
103 |
$14K |
| 59025 |
Fetal non-stress test |
179 |
106 |
$5K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
24 |
24 |
$2K |
| H2010 |
Comprehensive medication services, per 15 minutes |
66 |
62 |
$2K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
12 |
12 |
$2K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
14 |
14 |
$1K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
555 |
297 |
$1K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
494 |
493 |
$755.00 |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
81 |
80 |
$689.07 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,285 |
1,267 |
$660.06 |
| 90686 |
|
674 |
673 |
$657.00 |
| 92587 |
|
192 |
190 |
$480.15 |
| 81003 |
|
5,581 |
4,125 |
$336.36 |
| H0046 |
Mental health services, not otherwise specified |
74 |
59 |
$208.98 |
| 76801 |
|
24 |
24 |
$206.87 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
91 |
87 |
$188.48 |
| 85018 |
|
50 |
50 |
$34.02 |
| 90648 |
|
89 |
89 |
$10.00 |
| 1036F |
|
891 |
661 |
$0.00 |
| 3008F |
|
2,025 |
1,731 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
275 |
249 |
$0.00 |
| 99000 |
|
593 |
529 |
$0.00 |
| 3074F |
|
1,512 |
1,281 |
$0.00 |
| 1126F |
|
650 |
506 |
$0.00 |
| 90723 |
|
12 |
12 |
$0.00 |
| 88720 |
|
47 |
43 |
$0.00 |
| 1160F |
|
891 |
662 |
$0.00 |
| 3078F |
|
1,475 |
1,253 |
$0.00 |
| 90670 |
|
95 |
95 |
$0.00 |
| 90633 |
|
12 |
12 |
$0.00 |
| Q0091 |
Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory |
44 |
38 |
$0.00 |
| 3725F |
|
30 |
25 |
$0.00 |