| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,036 |
839 |
$40K |
| 59025 |
Fetal non-stress test |
1,775 |
1,068 |
$39K |
| 59400 |
Routine obstetric care including antepartum care, vaginal delivery, and postpartum care |
31 |
24 |
$38K |
| 76811 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, detailed |
123 |
107 |
$10K |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
171 |
136 |
$8K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
113 |
96 |
$8K |
| S0281 |
Medical home program, comprehensive care coordination and planning, maintenance of plan |
67 |
52 |
$7K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
188 |
151 |
$7K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
287 |
243 |
$6K |
| 76830 |
Ultrasound, transvaginal |
101 |
85 |
$4K |
| S0280 |
Medical home program, comprehensive care coordination and planning, initial plan |
46 |
44 |
$2K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
14 |
12 |
$570.49 |
| 81025 |
|
56 |
51 |
$311.96 |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
15 |
12 |
$266.41 |
| 1036F |
|
2,173 |
1,655 |
$143.44 |
| 96127 |
|
13 |
12 |
$62.51 |
| G8482 |
Influenza immunization administered or previously received |
477 |
371 |
$0.07 |
| 1126F |
|
2,061 |
1,654 |
$0.05 |
| 3008F |
|
1,776 |
1,406 |
$0.03 |
| 1159F |
|
2,039 |
1,604 |
$0.03 |
| 3074F |
|
1,109 |
896 |
$0.01 |
| 3078F |
|
1,018 |
830 |
$0.01 |
| 0503F |
|
150 |
129 |
$0.00 |
| 3075F |
|
13 |
12 |
$0.00 |
| 1111F |
|
34 |
25 |
$0.00 |
| 3079F |
|
117 |
106 |
$0.00 |
| 1125F |
|
345 |
280 |
$0.00 |
| G8866 |
Documentation of patient reason(s) for not administering or previously receiving pneumococcal vaccine (e.g., patient refusal) |
886 |
759 |
$0.00 |
| G8483 |
Influenza immunization was not administered for reasons documented by clinician (e.g., patient allergy or other medical reasons, patient declined or other patient reasons, vaccine not available or other system reasons) |
755 |
645 |
$0.00 |
| 1160F |
|
78 |
58 |
$0.00 |
| 3077F |
|
12 |
12 |
$0.00 |