| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,721 |
1,383 |
$87K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
488 |
474 |
$47K |
| 59400 |
Routine obstetric care including antepartum care, vaginal delivery, and postpartum care |
25 |
25 |
$37K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
387 |
339 |
$27K |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
364 |
352 |
$25K |
| S0280 |
Medical home program, comprehensive care coordination and planning, initial plan |
398 |
392 |
$18K |
| 99199 |
Unlisted special service, procedure or report |
4,065 |
3,880 |
$18K |
| 81025 |
|
2,413 |
2,225 |
$16K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
181 |
164 |
$14K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
59 |
57 |
$6K |
| 59025 |
Fetal non-stress test |
61 |
25 |
$2K |
| 99442 |
|
137 |
98 |
$2K |
| S0281 |
Medical home program, comprehensive care coordination and planning, maintenance of plan |
13 |
13 |
$2K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
18 |
18 |
$1K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
32 |
29 |
$519.96 |
| 87210 |
|
44 |
41 |
$164.50 |