| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J7296 |
Levonorgestrel-releasing intrauterine contraceptive system, (kyleena), 19.5 mg |
857 |
857 |
$1.02M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
42,163 |
34,229 |
$971K |
| 58740 |
|
1,139 |
1,136 |
$742K |
| J7298 |
Levonorgestrel-releasing intrauterine contraceptive system (mirena), 52 mg |
478 |
477 |
$563K |
| 59425 |
|
9,832 |
6,430 |
$524K |
| J7307 |
Etonogestrel (contraceptive) implant system, including implant and supplies |
393 |
392 |
$468K |
| 99215 |
Prolong outpt/office vis |
4,124 |
4,069 |
$464K |
| 76811 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, detailed |
2,833 |
2,639 |
$395K |
| 58662 |
|
1,814 |
1,811 |
$394K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
4,653 |
4,571 |
$249K |
| 58558 |
|
2,075 |
2,063 |
$231K |
| 76801 |
|
2,982 |
2,796 |
$207K |
| 58300 |
|
1,361 |
1,356 |
$205K |
| 59400 |
Routine obstetric care including antepartum care, vaginal delivery, and postpartum care |
158 |
157 |
$199K |
| 59409 |
Vaginal delivery only (with or without episiotomy and/or forceps) |
391 |
391 |
$198K |
| 76830 |
Ultrasound, transvaginal |
1,971 |
1,954 |
$118K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
1,969 |
1,967 |
$115K |
| 0500F |
|
1,700 |
1,696 |
$113K |
| 58563 |
|
73 |
73 |
$111K |
| 59430 |
|
1,629 |
1,515 |
$88K |
| 76700 |
Ultrasound, abdominal, real time with image documentation; complete |
1,119 |
1,117 |
$86K |
| 59514 |
|
177 |
175 |
$86K |
| 11981 |
|
386 |
384 |
$79K |
| 99385 |
|
787 |
787 |
$77K |
| 99386 |
|
610 |
609 |
$62K |
| 3351F |
|
904 |
904 |
$50K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
509 |
508 |
$46K |
| 99285 |
Emergency department visit for the evaluation and management, high severity with immediate threat to life |
448 |
428 |
$45K |
| 59510 |
|
37 |
37 |
$41K |
| Z1032 |
|
246 |
246 |
$31K |
| Z1034 |
|
406 |
288 |
$28K |
| 57452 |
|
577 |
576 |
$27K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
264 |
263 |
$22K |
| 57511 |
|
293 |
292 |
$19K |
| 58555 |
|
222 |
221 |
$19K |
| 59025 |
Fetal non-stress test |
718 |
612 |
$14K |
| 58671 |
|
64 |
64 |
$14K |
| 76856 |
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete |
201 |
201 |
$13K |
| 58301 |
|
299 |
295 |
$12K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
122 |
97 |
$11K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
276 |
271 |
$10K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
145 |
145 |
$10K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
344 |
344 |
$6K |
| 88141 |
|
61 |
61 |
$3K |
| 3353F |
|
50 |
50 |
$3K |
| 81025 |
|
985 |
978 |
$3K |
| 99223 |
Prolong inpt eval add15 m |
17 |
17 |
$1K |
| 11976 |
|
12 |
12 |
$1K |