| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| H1000 |
Prenatal care, at-risk assessment |
9,815 |
5,503 |
$455K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
15,556 |
9,682 |
$408K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
4,399 |
2,852 |
$157K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
3,138 |
2,029 |
$154K |
| 99386 |
|
3,498 |
2,073 |
$153K |
| 99385 |
|
4,729 |
2,717 |
$145K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
3,359 |
2,090 |
$125K |
| 59430 |
|
982 |
784 |
$80K |
| J7297 |
Levonorgestrel-releasing intrauterine contraceptive system (liletta), 52 mg |
180 |
113 |
$74K |
| 57454 |
|
1,507 |
836 |
$61K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,555 |
1,102 |
$54K |
| H1001 |
Prenatal care, at-risk enhanced service; antepartum management |
472 |
373 |
$52K |
| 76857 |
|
1,988 |
1,285 |
$32K |
| J7307 |
Etonogestrel (contraceptive) implant system, including implant and supplies |
105 |
53 |
$31K |
| 99459 |
|
2,109 |
1,933 |
$28K |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
794 |
624 |
$27K |
| 76998 |
|
1,273 |
706 |
$13K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
489 |
253 |
$13K |
| 58301 |
|
895 |
381 |
$12K |
| 76856 |
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete |
607 |
261 |
$8K |
| 99443 |
|
394 |
377 |
$6K |
| 81025 |
|
6,186 |
3,584 |
$5K |
| 58300 |
|
1,205 |
678 |
$5K |
| 57456 |
|
315 |
133 |
$4K |
| 58100 |
|
80 |
40 |
$3K |
| 99442 |
|
172 |
149 |
$2K |
| 81005 |
|
8,567 |
5,083 |
$2K |
| G2211 |
Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient's single, serious condition or a complex condition. (add-on code, list separately in addition to office/outpatient evaluation and management visit, new or established) |
261 |
240 |
$1K |
| 11981 |
|
67 |
39 |
$804.10 |
| G0101 |
Cervical or vaginal cancer screening; pelvic and clinical breast examination |
16 |
12 |
$647.73 |
| 99215 |
Prolong outpt/office vis |
67 |
35 |
$543.76 |
| Q0091 |
Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory |
17 |
12 |
$0.00 |
| G0439 |
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit |
15 |
12 |
$0.00 |