| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 59400 |
Routine obstetric care including antepartum care, vaginal delivery, and postpartum care |
1,108 |
968 |
$1.43M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
12,798 |
10,042 |
$600K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
4,462 |
3,633 |
$372K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
8,705 |
6,186 |
$264K |
| 59410 |
|
303 |
253 |
$219K |
| 59510 |
|
133 |
115 |
$168K |
| 99199 |
Unlisted special service, procedure or report |
41,935 |
39,465 |
$151K |
| 76801 |
|
2,006 |
1,512 |
$149K |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
2,437 |
1,846 |
$136K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
3,111 |
2,529 |
$117K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
1,312 |
991 |
$114K |
| S0281 |
Medical home program, comprehensive care coordination and planning, maintenance of plan |
936 |
738 |
$101K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,383 |
1,180 |
$97K |
| 81025 |
|
16,032 |
12,376 |
$94K |
| 76819 |
Fetal biophysical profile; without non-stress testing |
1,284 |
722 |
$76K |
| S0280 |
Medical home program, comprehensive care coordination and planning, initial plan |
1,779 |
1,505 |
$72K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
3,351 |
2,304 |
$38K |
| 54150 |
|
148 |
139 |
$29K |
| 99205 |
Prolong outpt/office vis |
218 |
161 |
$22K |
| 59515 |
|
47 |
29 |
$22K |
| 81003 |
|
9,133 |
6,960 |
$19K |
| 76830 |
Ultrasound, transvaginal |
287 |
233 |
$18K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
251 |
225 |
$18K |
| 99385 |
|
151 |
137 |
$15K |
| 59426 |
|
13 |
12 |
$8K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
67 |
64 |
$7K |
| 85018 |
|
3,134 |
2,437 |
$7K |
| 99215 |
Prolong outpt/office vis |
58 |
56 |
$5K |
| 82947 |
|
1,451 |
1,002 |
$5K |
| 82950 |
|
1,029 |
829 |
$5K |
| 90674 |
|
290 |
205 |
$4K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
64 |
41 |
$3K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
297 |
237 |
$3K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
26 |
24 |
$2K |
| 57454 |
|
12 |
12 |
$1K |
| 76857 |
|
19 |
13 |
$1K |
| 99386 |
|
15 |
13 |
$1K |
| 87210 |
|
66 |
52 |
$236.98 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
14 |
13 |
$211.97 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
35 |
25 |
$190.15 |
| 0503F |
|
375 |
229 |
$0.22 |
| 0500F |
|
108 |
79 |
$0.07 |
| 90715 |
|
12 |
12 |
$0.00 |
| 0502F |
|
12 |
12 |
$0.00 |
| 0501F |
|
129 |
79 |
$0.00 |
| 90686 |
|
29 |
20 |
$0.00 |