| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| H1000 |
Prenatal care, at-risk assessment |
2,801 |
1,710 |
$128K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,871 |
2,147 |
$46K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
791 |
729 |
$31K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
316 |
282 |
$30K |
| H1001 |
Prenatal care, at-risk enhanced service; antepartum management |
122 |
75 |
$14K |
| 76856 |
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete |
311 |
277 |
$10K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
130 |
117 |
$9K |
| 59430 |
|
123 |
99 |
$6K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
67 |
55 |
$6K |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
234 |
186 |
$4K |
| 99385 |
|
17 |
14 |
$3K |
| 81025 |
|
1,154 |
981 |
$2K |
| 81003 |
|
3,849 |
2,490 |
$2K |
| G0101 |
Cervical or vaginal cancer screening; pelvic and clinical breast examination |
364 |
278 |
$2K |
| 76801 |
|
21 |
19 |
$478.24 |
| 0012A |
|
21 |
21 |
$200.00 |
| 80306 |
|
68 |
50 |
$197.76 |
| 99401 |
|
132 |
87 |
$182.67 |
| H0049 |
Alcohol and/or drug screening |
50 |
27 |
$138.00 |
| 0011A |
|
12 |
12 |
$80.00 |
| 1159F |
|
5,879 |
4,303 |
$9.64 |
| 3028F |
|
3,733 |
2,872 |
$0.00 |
| 1160F |
|
5,845 |
4,276 |
$0.00 |
| 3078F |
|
1,653 |
1,250 |
$0.00 |
| G8417 |
Bmi is documented above normal parameters and a follow-up plan is documented |
518 |
424 |
$0.00 |
| G0444 |
Annual depression screening, 5 to 15 minutes |
435 |
345 |
$0.00 |
| Q0091 |
Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory |
251 |
192 |
$0.00 |
| 2028F |
|
29 |
24 |
$0.00 |
| 80305 |
|
61 |
27 |
$0.00 |
| G8783 |
Normal blood pressure reading documented, follow-up not required |
20 |
13 |
$0.00 |
| 2010F |
|
3,283 |
2,490 |
$0.00 |
| 1170F |
|
5,145 |
3,819 |
$0.00 |
| 3074F |
|
1,963 |
1,485 |
$0.00 |
| 1111F |
|
65 |
54 |
$0.00 |
| 2001F |
|
1,673 |
1,425 |
$0.00 |
| 1125F |
|
355 |
284 |
$0.00 |
| 1126F |
|
3,323 |
2,475 |
$0.00 |
| G8420 |
Bmi is documented within normal parameters and no follow-up plan is required |
615 |
472 |
$0.00 |
| 2000F |
|
1,575 |
1,342 |
$0.00 |
| 91301 |
|
39 |
38 |
$0.00 |
| G0442 |
Annual alcohol misuse screening, 5 to 15 minutes |
345 |
287 |
$0.00 |
| 3008F |
|
1,851 |
1,391 |
$0.00 |
| 3079F |
|
282 |
251 |
$0.00 |
| 3080F |
|
15 |
13 |
$0.00 |
| 1036F |
|
216 |
184 |
$0.00 |
| 3075F |
|
29 |
24 |
$0.00 |