| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| H1001 |
Prenatal care, at-risk enhanced service; antepartum management |
2,413 |
1,202 |
$388K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
3,411 |
3,224 |
$239K |
| T1001 |
Nursing assessment / evaluation |
1,245 |
839 |
$209K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
3,188 |
3,143 |
$61K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
382 |
377 |
$41K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,279 |
1,263 |
$36K |
| 90461 |
|
994 |
986 |
$19K |
| 81025 |
|
2,785 |
2,734 |
$18K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
252 |
251 |
$12K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
226 |
224 |
$10K |
| 99201 |
|
356 |
353 |
$10K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
521 |
520 |
$8K |
| Q0111 |
Wet mounts, including preparations of vaginal, cervical or skin specimens |
1,396 |
1,365 |
$4K |
| 99502 |
|
21 |
13 |
$4K |
| 90715 |
|
590 |
580 |
$1K |
| 11981 |
|
12 |
12 |
$1K |
| 90651 |
|
350 |
341 |
$797.72 |
| 90686 |
|
686 |
678 |
$459.76 |
| 90716 |
|
12 |
12 |
$119.94 |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
196 |
187 |
$114.46 |
| S4993 |
Contraceptive pills for birth control |
12 |
12 |
$100.71 |
| 90734 |
|
189 |
187 |
$100.69 |
| 90707 |
|
12 |
12 |
$69.41 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
13 |
13 |
$50.44 |
| 90619 |
|
48 |
47 |
$0.00 |
| 90647 |
|
12 |
12 |
$0.00 |
| 90696 |
|
17 |
17 |
$0.00 |
| 90723 |
|
12 |
12 |
$0.00 |
| 90710 |
|
145 |
145 |
$0.00 |
| 90633 |
|
415 |
411 |
$0.00 |