| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 59400 |
Routine obstetric care including antepartum care, vaginal delivery, and postpartum care |
344 |
307 |
$441K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
1,186 |
917 |
$109K |
| S0281 |
Medical home program, comprehensive care coordination and planning, maintenance of plan |
736 |
582 |
$87K |
| 59430 |
|
733 |
585 |
$69K |
| 76801 |
|
598 |
415 |
$44K |
| S0280 |
Medical home program, comprehensive care coordination and planning, initial plan |
1,048 |
823 |
$37K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
718 |
390 |
$25K |
| 59426 |
|
91 |
31 |
$23K |
| 99442 |
|
181 |
156 |
$9K |
| 59425 |
|
61 |
18 |
$6K |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
69 |
59 |
$5K |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
42 |
29 |
$3K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
91 |
31 |
$3K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
210 |
91 |
$2K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
19 |
13 |
$1K |
| 90686 |
|
19 |
16 |
$283.84 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
25 |
16 |
$234.25 |
| 81025 |
|
32 |
25 |
$187.20 |
| 87210 |
|
30 |
13 |
$32.90 |
| 81002 |
|
43 |
32 |
$9.45 |