| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
2,367 |
1,407 |
$116K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
346 |
206 |
$46K |
| Z1034 |
|
285 |
187 |
$16K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
281 |
146 |
$13K |
| J3490 |
Unclassified drugs |
161 |
87 |
$13K |
| Z1032 |
|
60 |
60 |
$9K |
| Z6500 |
|
64 |
64 |
$8K |
| A4267 |
Contraceptive supply, condom, male, each |
429 |
424 |
$5K |
| 59409 |
Vaginal delivery only (with or without episiotomy and/or forceps) |
18 |
18 |
$3K |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
86 |
86 |
$3K |
| Z6400 |
|
207 |
162 |
$2K |
| S9445 |
Patient education, not otherwise classified, non-physician provider, individual, per session |
220 |
218 |
$2K |
| 76813 |
|
32 |
26 |
$2K |
| 81025 |
|
802 |
792 |
$2K |
| Z6204 |
|
174 |
134 |
$2K |
| Z6406 |
|
149 |
122 |
$1K |
| 99402 |
|
34 |
34 |
$1K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
53 |
53 |
$1K |
| Z6304 |
|
91 |
80 |
$759.30 |
| Z1038 |
|
12 |
12 |
$658.61 |
| Z6410 |
|
69 |
50 |
$651.80 |
| 99401 |
|
153 |
132 |
$438.61 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
609 |
523 |
$420.04 |
| 81002 |
|
280 |
202 |
$376.02 |
| 92552 |
|
107 |
107 |
$370.37 |
| 90670 |
|
66 |
66 |
$279.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
49 |
49 |
$226.92 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
15 |
15 |
$193.30 |
| S0197 |
Prenatal vitamins, 30-day supply |
170 |
107 |
$189.70 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
41 |
41 |
$177.06 |
| 90680 |
|
25 |
25 |
$162.00 |
| Z6414 |
|
15 |
13 |
$152.16 |
| 90723 |
|
13 |
13 |
$108.00 |
| 90630 |
|
106 |
106 |
$92.40 |
| 92081 |
|
72 |
72 |
$56.34 |
| 90647 |
|
18 |
18 |
$45.00 |
| 81000 |
|
80 |
80 |
$41.64 |
| 85018 |
|
74 |
72 |
$28.87 |
| 90633 |
|
22 |
22 |
$18.00 |
| 90707 |
|
16 |
15 |
$18.00 |
| 90716 |
|
19 |
18 |
$18.00 |
| 86580 |
|
14 |
14 |
$6.66 |
| H1003 |
Prenatal care, at-risk enhanced service; education |
232 |
154 |
$0.00 |
| 59425 |
|
312 |
201 |
$0.00 |
| 99215 |
Prolong outpt/office vis |
15 |
15 |
$0.00 |
| 97803 |
|
144 |
117 |
$0.00 |
| 59430 |
|
17 |
15 |
$0.00 |
| 96151 |
|
79 |
73 |
$0.00 |
| H2000 |
Comprehensive multidisciplinary evaluation |
39 |
39 |
$0.00 |
| S9452 |
Nutrition classes, non-physician provider, per session |
14 |
14 |
$0.00 |