| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,842 |
1,622 |
$93K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,373 |
1,251 |
$80K |
| J3490 |
Unclassified drugs |
471 |
425 |
$40K |
| Z1034 |
|
688 |
463 |
$38K |
| 59425 |
|
1,004 |
659 |
$27K |
| Z6410 |
|
656 |
425 |
$5K |
| 81025 |
|
1,995 |
1,890 |
$5K |
| Z1032 |
|
28 |
28 |
$5K |
| 99000 |
|
1,968 |
1,836 |
$5K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
172 |
161 |
$4K |
| Z6500 |
|
26 |
26 |
$3K |
| 99384 |
|
28 |
14 |
$3K |
| S0197 |
Prenatal vitamins, 30-day supply |
1,643 |
886 |
$2K |
| 99383 |
|
15 |
15 |
$2K |
| Z6400 |
|
137 |
121 |
$2K |
| 76801 |
|
30 |
30 |
$2K |
| 92551 |
|
175 |
175 |
$2K |
| 97802 |
|
54 |
54 |
$2K |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
72 |
72 |
$789.01 |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
12 |
12 |
$597.20 |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
17 |
17 |
$493.76 |
| 85018 |
|
278 |
267 |
$489.11 |
| 90633 |
|
38 |
38 |
$342.00 |
| 82947 |
|
76 |
76 |
$149.46 |
| 88141 |
|
13 |
13 |
$135.46 |
| 90716 |
|
14 |
14 |
$126.00 |
| 90734 |
|
14 |
14 |
$126.00 |
| 81002 |
|
77 |
67 |
$120.73 |
| 90744 |
|
12 |
12 |
$108.00 |
| 90715 |
|
12 |
12 |
$108.00 |
| 86580 |
|
13 |
13 |
$43.29 |
| 92557 |
|
14 |
14 |
$34.44 |
| 85014 |
|
14 |
14 |
$1.70 |
| H1000 |
Prenatal care, at-risk assessment |
24 |
14 |
$0.00 |
| H1003 |
Prenatal care, at-risk enhanced service; education |
18 |
13 |
$0.00 |
| 0502F |
|
43 |
31 |
$0.00 |