| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0281 |
Medical home program, comprehensive care coordination and planning, maintenance of plan |
448 |
382 |
$57K |
| S0280 |
Medical home program, comprehensive care coordination and planning, initial plan |
1,328 |
1,095 |
$54K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
728 |
546 |
$44K |
| 99215 |
Prolong outpt/office vis |
480 |
325 |
$39K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
563 |
431 |
$37K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
638 |
459 |
$32K |
| 99233 |
Prolong inpt eval add15 m |
422 |
290 |
$31K |
| 99205 |
Prolong outpt/office vis |
174 |
137 |
$22K |
| 76801 |
|
136 |
103 |
$9K |
| 99417 |
Prolong home eval add 15m |
29 |
29 |
$8K |
| 96127 |
|
1,060 |
903 |
$4K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
39 |
26 |
$4K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
29 |
26 |
$3K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
318 |
318 |
$3K |
| 59025 |
Fetal non-stress test |
15 |
12 |
$485.16 |