| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| H1000 |
Prenatal care, at-risk assessment |
7,267 |
3,976 |
$388K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,489 |
1,930 |
$135K |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
3,933 |
2,269 |
$115K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
992 |
846 |
$107K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
3,015 |
2,560 |
$95K |
| 59410 |
|
70 |
64 |
$62K |
| H1001 |
Prenatal care, at-risk enhanced service; antepartum management |
547 |
460 |
$40K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
813 |
653 |
$38K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
414 |
394 |
$28K |
| 59430 |
|
464 |
397 |
$27K |
| 59515 |
|
12 |
12 |
$14K |
| 76801 |
|
348 |
253 |
$14K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
360 |
338 |
$11K |
| 81025 |
|
2,057 |
1,737 |
$9K |
| 76830 |
Ultrasound, transvaginal |
245 |
200 |
$7K |
| 76820 |
|
503 |
350 |
$5K |
| 76819 |
Fetal biophysical profile; without non-stress testing |
175 |
138 |
$3K |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
176 |
147 |
$3K |
| 59025 |
Fetal non-stress test |
25 |
15 |
$1K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
126 |
122 |
$1K |
| 76818 |
|
25 |
14 |
$782.00 |
| 99385 |
|
12 |
12 |
$743.20 |
| 81002 |
|
193 |
168 |
$699.84 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
32 |
32 |
$456.78 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
29 |
27 |
$270.65 |
| 58300 |
|
20 |
12 |
$229.02 |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
41 |
41 |
$90.12 |
| 96127 |
|
95 |
60 |
$52.00 |
| 99024 |
|
21 |
19 |
$0.00 |