| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
7,235 |
6,527 |
$486K |
| Z1034 |
|
4,676 |
3,069 |
$257K |
| Z1032 |
|
660 |
660 |
$98K |
| J3490 |
Unclassified drugs |
1,035 |
919 |
$77K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
1,119 |
1,103 |
$69K |
| Z6500 |
|
384 |
384 |
$48K |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
759 |
759 |
$37K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
174 |
174 |
$32K |
| 59409 |
Vaginal delivery only (with or without episiotomy and/or forceps) |
72 |
72 |
$30K |
| H1001 |
Prenatal care, at-risk enhanced service; antepartum management |
741 |
496 |
$22K |
| Z6400 |
|
1,883 |
1,526 |
$21K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
367 |
366 |
$16K |
| 81025 |
|
4,737 |
4,522 |
$14K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
184 |
175 |
$14K |
| 99000 |
|
4,552 |
4,111 |
$13K |
| Z6204 |
|
1,375 |
1,152 |
$13K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
297 |
296 |
$11K |
| Z6410 |
|
960 |
765 |
$9K |
| A4267 |
Contraceptive supply, condom, male, each |
768 |
761 |
$9K |
| 59425 |
|
298 |
204 |
$8K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
159 |
159 |
$8K |
| Z1038 |
|
143 |
143 |
$8K |
| Z6406 |
|
686 |
600 |
$7K |
| 81002 |
|
3,403 |
2,408 |
$5K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
12 |
12 |
$4K |
| S9445 |
Patient education, not otherwise classified, non-physician provider, individual, per session |
334 |
321 |
$3K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
54 |
54 |
$3K |
| 92552 |
|
187 |
187 |
$3K |
| 76813 |
|
27 |
27 |
$2K |
| 92551 |
|
203 |
203 |
$2K |
| 90670 |
|
252 |
249 |
$2K |
| 57454 |
|
31 |
16 |
$2K |
| 85018 |
|
781 |
780 |
$2K |
| 81000 |
|
592 |
591 |
$2K |
| 99381 |
|
12 |
12 |
$1K |
| Z6304 |
|
148 |
146 |
$1K |
| 90658 |
|
116 |
116 |
$1K |
| S0197 |
Prenatal vitamins, 30-day supply |
724 |
638 |
$993.15 |
| Z6208 |
|
75 |
69 |
$987.88 |
| Z6414 |
|
74 |
69 |
$866.77 |
| 90686 |
|
89 |
89 |
$783.00 |
| 90715 |
|
15 |
15 |
$531.80 |
| 90633 |
|
65 |
63 |
$459.00 |
| H1003 |
Prenatal care, at-risk enhanced service; education |
213 |
172 |
$424.16 |
| 90700 |
|
48 |
47 |
$378.00 |
| 90647 |
|
51 |
50 |
$364.50 |
| Z6308 |
|
38 |
37 |
$327.78 |
| 90688 |
|
32 |
32 |
$288.00 |
| Z6412 |
|
12 |
12 |
$246.82 |
| 90723 |
|
27 |
27 |
$207.00 |
| 90649 |
|
25 |
25 |
$207.00 |
| 90648 |
|
24 |
24 |
$162.00 |
| 90680 |
|
25 |
25 |
$144.00 |
| 90651 |
|
12 |
12 |
$108.00 |
| 90650 |
|
14 |
14 |
$90.00 |
| 90681 |
|
12 |
12 |
$90.00 |
| 97803 |
|
216 |
180 |
$82.34 |
| 99401 |
|
184 |
150 |
$67.30 |
| 92081 |
|
25 |
25 |
$30.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
16 |
15 |
$19.26 |
| 90685 |
|
12 |
12 |
$18.00 |
| 3008F |
|
288 |
284 |
$0.00 |
| 96151 |
|
41 |
40 |
$0.00 |
| 3074F |
|
109 |
93 |
$0.00 |
| 3080F |
|
12 |
12 |
$0.00 |
| 0502F |
|
138 |
105 |
$0.00 |
| 3078F |
|
110 |
93 |
$0.00 |
| 3077F |
|
12 |
12 |
$0.00 |