| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| H1000 |
Prenatal care, at-risk assessment |
9,124 |
4,892 |
$665K |
| 59410 |
|
292 |
289 |
$327K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
3,966 |
3,315 |
$205K |
| 59430 |
|
736 |
607 |
$108K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
1,108 |
1,030 |
$103K |
| 76830 |
Ultrasound, transvaginal |
1,069 |
1,028 |
$102K |
| 76818 |
|
752 |
651 |
$85K |
| 59025 |
Fetal non-stress test |
3,445 |
1,719 |
$77K |
| 81025 |
|
2,638 |
2,454 |
$73K |
| H1001 |
Prenatal care, at-risk enhanced service; antepartum management |
486 |
456 |
$71K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
676 |
620 |
$66K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
319 |
301 |
$44K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
593 |
579 |
$41K |
| 76819 |
Fetal biophysical profile; without non-stress testing |
683 |
651 |
$29K |
| 99385 |
|
278 |
246 |
$26K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
892 |
869 |
$18K |
| 76801 |
|
199 |
181 |
$16K |
| 87110 |
|
1,137 |
1,065 |
$7K |
| 87143 |
|
1,111 |
1,043 |
$5K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
54 |
50 |
$5K |
| 87210 |
|
1,812 |
1,711 |
$3K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
29 |
28 |
$3K |
| 82270 |
|
1,017 |
938 |
$2K |
| 76856 |
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete |
23 |
18 |
$2K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
25 |
12 |
$844.91 |
| H0049 |
Alcohol and/or drug screening |
37 |
36 |
$767.70 |
| 87081 |
|
36 |
34 |
$194.20 |
| 81002 |
|
69 |
58 |
$126.56 |
| 88150 |
|
34 |
34 |
$0.00 |