| Code | Description | Claims | Beneficiaries | Total Paid |
| H1001 |
Prenatal care, at-risk enhanced service; antepartum management |
12,056 |
7,890 |
$894K |
| 59409 |
Vaginal delivery only (with or without episiotomy and/or forceps) |
1,086 |
1,083 |
$792K |
| 59425 |
|
5,372 |
3,348 |
$403K |
| 59514 |
|
476 |
460 |
$269K |
| H1000 |
Prenatal care, at-risk assessment |
1,470 |
1,449 |
$269K |
| 59430 |
|
1,683 |
1,642 |
$128K |
| 99215 |
Prolong outpt/office vis |
653 |
650 |
$119K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,378 |
2,003 |
$116K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,558 |
2,185 |
$85K |
| 76801 |
|
932 |
823 |
$41K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
182 |
181 |
$15K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
174 |
138 |
$14K |
| J7301 |
Levonorgestrel-releasing intrauterine contraceptive system (skyla), 13.5 mg |
15 |
15 |
$11K |
| 58300 |
|
86 |
41 |
$9K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
44 |
44 |
$6K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
68 |
68 |
$5K |
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
81 |
81 |
$5K |
| 76813 |
|
36 |
36 |
$4K |
| 59025 |
Fetal non-stress test |
135 |
40 |
$3K |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
100 |
74 |
$3K |
| 96156 |
|
175 |
174 |
$2K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
73 |
70 |
$2K |
| 81025 |
|
600 |
581 |
$1K |
| H1003 |
Prenatal care, at-risk enhanced service; education |
14 |
14 |
$403.68 |
| 99401 |
|
122 |
122 |
$33.64 |
| 97803 |
|
122 |
122 |
$33.64 |
| 97802 |
|
36 |
36 |
$16.82 |
| 99403 |
|
36 |
36 |
$8.41 |
| H1002 |
Prenatal care, at risk enhanced service; care coordination |
37 |
37 |
$0.00 |