| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
3,547 |
2,553 |
$226K |
| 59400 |
Routine obstetric care including antepartum care, vaginal delivery, and postpartum care |
155 |
132 |
$188K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
3,055 |
2,041 |
$137K |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
1,731 |
1,393 |
$131K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
1,215 |
997 |
$117K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
948 |
720 |
$83K |
| S0281 |
Medical home program, comprehensive care coordination and planning, maintenance of plan |
566 |
447 |
$65K |
| 59025 |
Fetal non-stress test |
2,099 |
907 |
$58K |
| S0280 |
Medical home program, comprehensive care coordination and planning, initial plan |
1,152 |
928 |
$45K |
| 99215 |
Prolong outpt/office vis |
324 |
234 |
$28K |
| 76801 |
|
269 |
226 |
$23K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
191 |
145 |
$16K |
| 99199 |
Unlisted special service, procedure or report |
6,156 |
6,026 |
$16K |
| 81025 |
|
2,619 |
1,896 |
$14K |
| 76830 |
Ultrasound, transvaginal |
187 |
154 |
$12K |
| 81002 |
|
4,231 |
2,297 |
$8K |
| 99401 |
|
154 |
96 |
$4K |
| 76811 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, detailed |
21 |
14 |
$3K |
| 81003 |
|
1,208 |
791 |
$3K |
| 96127 |
|
759 |
650 |
$3K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
29 |
25 |
$2K |
| 99238 |
Hospital discharge day management, 30 minutes or less |
37 |
24 |
$1K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
43 |
33 |
$464.35 |
| 90688 |
|
36 |
31 |
$442.76 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
26 |
13 |
$396.72 |
| 99072 |
|
1,260 |
894 |
$48.08 |
| 99000 |
|
2,034 |
1,561 |
$15.26 |
| 0502F |
|
41 |
22 |
$0.00 |