| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,701 |
1,949 |
$128K |
| H1005 |
Prenatal care, at-risk enhanced service package (includes h1001-h1004) |
231 |
217 |
$111K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,490 |
1,191 |
$111K |
| 76830 |
Ultrasound, transvaginal |
431 |
379 |
$27K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
131 |
102 |
$14K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
116 |
111 |
$12K |
| 81025 |
|
1,157 |
879 |
$7K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
411 |
370 |
$7K |
| 36415 |
Collection of venous blood by venipuncture |
2,379 |
1,974 |
$6K |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
82 |
75 |
$6K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
57 |
52 |
$4K |
| 90686 |
|
242 |
220 |
$4K |
| 59025 |
Fetal non-stress test |
105 |
80 |
$3K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
52 |
39 |
$3K |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
42 |
40 |
$3K |
| 90715 |
|
25 |
25 |
$1K |
| 81002 |
|
202 |
170 |
$521.31 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
16 |
13 |
$475.17 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
49 |
44 |
$460.10 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
30 |
26 |
$348.64 |
| 85018 |
|
12 |
12 |
$26.07 |
| 81003 |
|
22 |
14 |
$7.02 |
| 0503F |
|
15 |
15 |
$0.00 |
| 0502F |
|
1,023 |
832 |
$0.00 |