| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 59400 |
Routine obstetric care including antepartum care, vaginal delivery, and postpartum care |
152 |
138 |
$164K |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
1,783 |
1,430 |
$83K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,192 |
1,703 |
$70K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
639 |
549 |
$49K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
805 |
563 |
$45K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
528 |
388 |
$28K |
| 59025 |
Fetal non-stress test |
965 |
561 |
$21K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
251 |
200 |
$13K |
| 76819 |
Fetal biophysical profile; without non-stress testing |
209 |
136 |
$11K |
| 59430 |
|
244 |
162 |
$10K |
| 0503F |
|
933 |
707 |
$9K |
| 81002 |
|
7,904 |
4,670 |
$5K |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
90 |
53 |
$4K |
| 0500F |
|
190 |
111 |
$2K |
| 76820 |
|
47 |
24 |
$2K |
| 76830 |
Ultrasound, transvaginal |
26 |
26 |
$2K |
| 81025 |
|
396 |
311 |
$2K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
70 |
53 |
$1K |
| 90715 |
|
36 |
24 |
$1K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
99 |
67 |
$513.19 |
| 99406 |
|
37 |
24 |
$277.12 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
14 |
12 |
$198.25 |
| 81003 |
|
29 |
23 |
$26.86 |
| 0502F |
|
7,253 |
4,034 |
$0.00 |
| 3511F |
|
380 |
272 |
$0.00 |
| 3293F |
|
391 |
280 |
$0.00 |
| 3513F |
|
356 |
256 |
$0.00 |
| 3294F |
|
451 |
397 |
$0.00 |
| 0501F |
|
640 |
534 |
$0.00 |
| 99024 |
|
14 |
12 |
$0.00 |
| 3512F |
|
345 |
244 |
$0.00 |
| 3514F |
|
176 |
113 |
$0.00 |
| 3292F |
|
380 |
269 |
$0.00 |