| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| H1000 |
Prenatal care, at-risk assessment |
5,063 |
2,838 |
$244K |
| 96369 |
|
792 |
575 |
$73K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,499 |
1,291 |
$65K |
| H1001 |
Prenatal care, at-risk enhanced service; antepartum management |
391 |
352 |
$49K |
| 59430 |
|
700 |
616 |
$34K |
| 99215 |
Prolong outpt/office vis |
320 |
256 |
$26K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
342 |
331 |
$25K |
| 96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour |
772 |
560 |
$23K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
233 |
219 |
$20K |
| 76801 |
|
434 |
374 |
$15K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
365 |
343 |
$15K |
| 96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; each additional hour |
777 |
564 |
$7K |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
157 |
147 |
$6K |
| 59025 |
Fetal non-stress test |
195 |
137 |
$4K |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
74 |
69 |
$4K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
128 |
102 |
$4K |
| 96360 |
Intravenous infusion, hydration; initial, 31 minutes to 1 hour |
234 |
165 |
$4K |
| 99385 |
|
84 |
76 |
$4K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
94 |
83 |
$3K |
| J3415 |
Injection, pyridoxine hcl, 100 mg |
858 |
558 |
$3K |
| 99245 |
|
41 |
28 |
$2K |
| 99205 |
Prolong outpt/office vis |
19 |
18 |
$2K |
| G0101 |
Cervical or vaginal cancer screening; pelvic and clinical breast examination |
64 |
59 |
$1K |
| 76856 |
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete |
18 |
18 |
$1K |
| J7040 |
Infusion, normal saline solution, sterile (500 ml = 1 unit) |
800 |
568 |
$797.18 |
| J3411 |
Injection, thiamine hcl, 100 mg |
924 |
593 |
$559.73 |
| J3420 |
Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg |
894 |
579 |
$330.54 |
| 81001 |
|
113 |
96 |
$257.82 |
| 81005 |
|
374 |
310 |
$225.87 |
| A4223 |
Infusion supplies not used with external infusion pump, per cassette or bag (list drugs separately) |
276 |
189 |
$176.21 |
| Q0091 |
Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory |
48 |
42 |
$155.02 |
| 96374 |
Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance |
14 |
12 |
$104.06 |
| 81025 |
|
17 |
14 |
$24.28 |
| J3475 |
Injection, magnesium sulfate, per 500 mg |
36 |
32 |
$11.74 |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
50 |
35 |
$11.31 |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
285 |
197 |
$10.70 |
| J3490 |
Unclassified drugs |
556 |
335 |
$5.89 |
| 99000 |
|
58 |
54 |
$0.00 |