| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J7301 |
Levonorgestrel-releasing intrauterine contraceptive system (skyla), 13.5 mg |
1,625 |
1,220 |
$1.15M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
11,113 |
9,276 |
$362K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
4,018 |
3,214 |
$361K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
2,425 |
2,285 |
$345K |
| 58300 |
|
2,949 |
1,779 |
$326K |
| Z1034 |
|
4,787 |
3,060 |
$288K |
| 76830 |
Ultrasound, transvaginal |
5,792 |
5,709 |
$253K |
| H1001 |
Prenatal care, at-risk enhanced service; antepartum management |
4,341 |
2,925 |
$230K |
| 76856 |
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete |
4,539 |
4,466 |
$163K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
3,402 |
3,188 |
$163K |
| J7307 |
Etonogestrel (contraceptive) implant system, including implant and supplies |
258 |
258 |
$150K |
| Z1032 |
|
909 |
909 |
$143K |
| Z6500 |
|
889 |
889 |
$103K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
1,318 |
1,274 |
$81K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
1,000 |
999 |
$79K |
| J7297 |
Levonorgestrel-releasing intrauterine contraceptive system (liletta), 52 mg |
114 |
97 |
$78K |
| 58301 |
|
2,233 |
1,153 |
$75K |
| 11981 |
|
662 |
363 |
$70K |
| J3490 |
Unclassified drugs |
460 |
383 |
$49K |
| 59425 |
|
1,243 |
849 |
$44K |
| 59409 |
Vaginal delivery only (with or without episiotomy and/or forceps) |
78 |
78 |
$34K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
175 |
157 |
$29K |
| 11976 |
|
419 |
220 |
$24K |
| 96156 |
|
1,970 |
1,555 |
$16K |
| J7296 |
Levonorgestrel-releasing intrauterine contraceptive system, (kyleena), 19.5 mg |
46 |
46 |
$16K |
| S9445 |
Patient education, not otherwise classified, non-physician provider, individual, per session |
1,238 |
1,238 |
$16K |
| 97803 |
|
1,777 |
1,390 |
$15K |
| 99401 |
|
1,775 |
1,390 |
$15K |
| Z6204 |
|
1,356 |
1,089 |
$10K |
| 81025 |
|
4,371 |
4,325 |
$10K |
| Z6304 |
|
1,344 |
1,079 |
$10K |
| Z6406 |
|
1,152 |
944 |
$8K |
| 59514 |
|
13 |
13 |
$6K |
| 59430 |
|
38 |
31 |
$4K |
| Z6400 |
|
195 |
194 |
$3K |
| 57454 |
|
26 |
13 |
$2K |
| 99442 |
|
77 |
73 |
$1K |
| H1000 |
Prenatal care, at-risk assessment |
13 |
13 |
$1K |
| S9452 |
Nutrition classes, non-physician provider, per session |
91 |
86 |
$758.03 |
| H2000 |
Comprehensive multidisciplinary evaluation |
91 |
86 |
$758.03 |
| Z6404 |
|
84 |
73 |
$635.90 |
| 81002 |
|
309 |
308 |
$539.40 |
| 0502F |
|
287 |
232 |
$0.00 |
| Q0091 |
Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory |
12 |
12 |
$0.00 |