| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| Z1034 |
|
2,782 |
1,555 |
$152K |
| H1001 |
Prenatal care, at-risk enhanced service; antepartum management |
2,539 |
1,485 |
$72K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
477 |
477 |
$56K |
| 59425 |
|
2,791 |
1,665 |
$47K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
903 |
839 |
$32K |
| Z6410 |
|
1,512 |
1,152 |
$24K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,489 |
1,393 |
$22K |
| Z6400 |
|
1,731 |
1,409 |
$18K |
| Z6500 |
|
143 |
143 |
$18K |
| Z1032 |
|
129 |
129 |
$17K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
369 |
345 |
$9K |
| H1003 |
Prenatal care, at-risk enhanced service; education |
1,932 |
1,383 |
$8K |
| 99402 |
|
119 |
118 |
$4K |
| 99000 |
|
2,378 |
2,263 |
$3K |
| 59514 |
|
13 |
13 |
$2K |
| S0197 |
Prenatal vitamins, 30-day supply |
1,427 |
1,053 |
$2K |
| S9445 |
Patient education, not otherwise classified, non-physician provider, individual, per session |
486 |
435 |
$2K |
| 76801 |
|
59 |
59 |
$1K |
| 99386 |
|
23 |
23 |
$1K |
| H2000 |
Comprehensive multidisciplinary evaluation |
12 |
12 |
$814.98 |
| 59430 |
|
12 |
12 |
$700.00 |
| Z1038 |
|
12 |
12 |
$653.16 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
26 |
26 |
$585.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
15 |
15 |
$405.00 |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
25 |
25 |
$276.28 |
| 81025 |
|
98 |
98 |
$221.59 |
| 96156 |
|
85 |
84 |
$201.84 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
12 |
12 |
$131.25 |
| Z6406 |
|
14 |
12 |
$105.98 |
| Z6204 |
|
14 |
12 |
$105.98 |
| Z6304 |
|
14 |
12 |
$105.98 |
| 0503F |
|
12 |
12 |
$100.00 |
| Z6414 |
|
12 |
12 |
$90.84 |
| Z6308 |
|
12 |
12 |
$90.84 |
| Z6208 |
|
12 |
12 |
$90.84 |
| 99401 |
|
19 |
18 |
$42.05 |
| 97803 |
|
19 |
18 |
$42.05 |
| 0500F |
|
108 |
107 |
$15.00 |