| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| H1000 |
Prenatal care, at-risk assessment |
368 |
357 |
$25K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,424 |
1,275 |
$13K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
758 |
674 |
$10K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
161 |
145 |
$4K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
168 |
151 |
$3K |
| 0012A |
|
226 |
120 |
$3K |
| 0011A |
|
222 |
124 |
$1K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
27 |
25 |
$1K |
| 90686 |
|
757 |
681 |
$1K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
13 |
13 |
$918.36 |
| 0064A |
|
61 |
31 |
$880.00 |
| 92551 |
|
37 |
36 |
$202.32 |
| 99173 |
|
37 |
36 |
$157.36 |
| 90656 |
|
81 |
53 |
$111.99 |
| 86580 |
|
34 |
32 |
$95.75 |
| 81025 |
|
15 |
15 |
$30.00 |
| A4267 |
Contraceptive supply, condom, male, each |
12 |
12 |
$9.77 |
| 91301 |
|
214 |
198 |
$0.04 |
| 90734 |
|
17 |
13 |
$0.00 |
| 90633 |
|
13 |
12 |
$0.00 |
| 91306 |
|
26 |
14 |
$0.00 |
| 90651 |
|
19 |
14 |
$0.00 |