| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| H1001 |
Prenatal care, at-risk enhanced service; antepartum management |
2,998 |
1,476 |
$495K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
6,364 |
6,065 |
$447K |
| T1001 |
Nursing assessment / evaluation |
2,620 |
1,637 |
$441K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
3,406 |
3,368 |
$95K |
| 99501 |
|
720 |
717 |
$66K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
424 |
417 |
$46K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
938 |
926 |
$45K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
2,358 |
2,316 |
$37K |
| 81025 |
|
4,979 |
4,909 |
$33K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
498 |
496 |
$24K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
1,543 |
1,532 |
$22K |
| 99502 |
|
112 |
97 |
$18K |
| 99201 |
|
595 |
591 |
$17K |
| Q0111 |
Wet mounts, including preparations of vaginal, cervical or skin specimens |
1,398 |
1,375 |
$4K |
| 90461 |
|
207 |
204 |
$4K |
| 11982 |
|
26 |
26 |
$3K |
| 90651 |
|
58 |
58 |
$779.94 |
| S4993 |
Contraceptive pills for birth control |
56 |
56 |
$508.40 |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
25 |
25 |
$437.00 |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
25 |
25 |
$437.00 |
| 90715 |
|
146 |
146 |
$379.95 |
| 90734 |
|
34 |
34 |
$353.58 |
| 90686 |
|
1,020 |
1,000 |
$258.28 |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
281 |
277 |
$178.51 |
| 90619 |
|
12 |
12 |
$0.00 |
| 90672 |
|
79 |
78 |
$0.00 |
| 90633 |
|
84 |
83 |
$0.00 |