| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 59400 |
Routine obstetric care including antepartum care, vaginal delivery, and postpartum care |
883 |
784 |
$1.03M |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
5,043 |
4,058 |
$281K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
2,869 |
2,625 |
$207K |
| 76801 |
|
1,845 |
1,456 |
$115K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,739 |
2,351 |
$100K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
1,141 |
1,033 |
$97K |
| 76819 |
Fetal biophysical profile; without non-stress testing |
1,561 |
1,271 |
$95K |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
1,648 |
1,481 |
$88K |
| 99385 |
|
659 |
551 |
$46K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
470 |
396 |
$42K |
| 59510 |
|
31 |
24 |
$40K |
| 99215 |
Prolong outpt/office vis |
402 |
343 |
$31K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
1,705 |
1,387 |
$26K |
| 81002 |
|
7,423 |
6,393 |
$18K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
202 |
194 |
$15K |
| 76856 |
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete |
210 |
185 |
$12K |
| 0500F |
|
1,670 |
1,320 |
$10K |
| 59426 |
|
20 |
15 |
$6K |
| 54150 |
|
40 |
36 |
$6K |
| 59425 |
|
21 |
20 |
$6K |
| 99205 |
Prolong outpt/office vis |
33 |
27 |
$4K |
| 81025 |
|
583 |
518 |
$3K |
| 76830 |
Ultrasound, transvaginal |
45 |
41 |
$3K |
| 90715 |
|
38 |
36 |
$2K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
20 |
14 |
$1K |
| 87210 |
|
322 |
268 |
$1K |
| 11981 |
|
18 |
12 |
$1K |
| 0503F |
|
435 |
410 |
$860.00 |
| 59025 |
Fetal non-stress test |
14 |
13 |
$470.94 |
| 3008F |
|
2,708 |
2,335 |
$416.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
54 |
50 |
$344.35 |
| 59430 |
|
17 |
14 |
$112.00 |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
18 |
12 |
$37.90 |
| 0502F |
|
105 |
86 |
$0.00 |
| 0501F |
|
1,034 |
906 |
$0.00 |