| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| H1000 |
Prenatal care, at-risk assessment |
3,068 |
2,718 |
$170K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
6,148 |
5,256 |
$135K |
| 76811 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, detailed |
778 |
743 |
$45K |
| H1001 |
Prenatal care, at-risk enhanced service; antepartum management |
95 |
93 |
$12K |
| 76819 |
Fetal biophysical profile; without non-stress testing |
335 |
244 |
$8K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
65 |
52 |
$5K |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
190 |
164 |
$4K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
125 |
103 |
$4K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
98 |
85 |
$2K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
319 |
229 |
$2K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
15 |
15 |
$1K |
| 76830 |
Ultrasound, transvaginal |
12 |
12 |
$286.26 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
32 |
28 |
$173.45 |
| 1159F |
|
921 |
882 |
$0.00 |
| 1160F |
|
891 |
854 |
$0.00 |
| 0521F |
|
52 |
49 |
$0.00 |
| 90670 |
|
14 |
14 |
$0.00 |
| 3078F |
|
427 |
389 |
$0.00 |
| 90700 |
|
12 |
12 |
$0.00 |
| 1036F |
|
359 |
312 |
$0.00 |
| 3074F |
|
589 |
541 |
$0.00 |
| 3075F |
|
40 |
38 |
$0.00 |
| 1126F |
|
480 |
427 |
$0.00 |
| 3079F |
|
187 |
178 |
$0.00 |
| 1125F |
|
400 |
362 |
$0.00 |
| G8420 |
Bmi is documented within normal parameters and no follow-up plan is required |
75 |
64 |
$0.00 |
| G8419 |
Bmi documented outside normal parameters, no follow-up plan documented, no reason given |
532 |
456 |
$0.00 |
| 1031F |
|
59 |
50 |
$0.00 |
| 1034F |
|
59 |
57 |
$0.00 |
| 1000F |
|
32 |
29 |
$0.00 |