| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| H1000 |
Prenatal care, at-risk assessment |
5,369 |
3,874 |
$297K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,405 |
2,098 |
$68K |
| 59410 |
|
59 |
55 |
$60K |
| H1001 |
Prenatal care, at-risk enhanced service; antepartum management |
304 |
298 |
$35K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
456 |
426 |
$31K |
| 59430 |
|
595 |
489 |
$30K |
| 99219 |
|
222 |
208 |
$20K |
| 59025 |
Fetal non-stress test |
557 |
340 |
$16K |
| 99220 |
|
114 |
108 |
$15K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
157 |
157 |
$15K |
| 59515 |
|
13 |
12 |
$14K |
| 76857 |
|
282 |
277 |
$11K |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
96 |
95 |
$7K |
| 76856 |
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete |
74 |
73 |
$5K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
194 |
170 |
$3K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
14 |
12 |
$1K |
| 81025 |
|
957 |
874 |
$895.30 |
| 87220 |
|
12 |
12 |
$0.00 |