| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 76818 |
|
2,839 |
1,147 |
$214K |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
3,110 |
2,356 |
$177K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
2,052 |
1,535 |
$137K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
1,169 |
867 |
$91K |
| 59426 |
|
164 |
145 |
$88K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,164 |
1,616 |
$79K |
| S0280 |
Medical home program, comprehensive care coordination and planning, initial plan |
2,095 |
1,540 |
$74K |
| 76801 |
|
953 |
708 |
$71K |
| S0281 |
Medical home program, comprehensive care coordination and planning, maintenance of plan |
840 |
514 |
$64K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
1,473 |
1,281 |
$64K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
3,776 |
2,392 |
$40K |
| 59400 |
Routine obstetric care including antepartum care, vaginal delivery, and postpartum care |
136 |
42 |
$40K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
383 |
295 |
$28K |
| 81025 |
|
3,560 |
2,713 |
$18K |
| 59430 |
|
178 |
140 |
$14K |
| 76856 |
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete |
151 |
134 |
$10K |
| 59025 |
Fetal non-stress test |
434 |
277 |
$7K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
118 |
109 |
$3K |
| 99459 |
|
261 |
224 |
$2K |
| 90715 |
|
13 |
13 |
$605.89 |
| 81003 |
|
283 |
243 |
$477.58 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
29 |
29 |
$409.32 |
| 99406 |
|
16 |
15 |
$185.12 |
| 99000 |
|
7,023 |
5,895 |
$23.09 |
| 0503F |
|
325 |
199 |
$0.00 |
| 0501F |
|
831 |
705 |
$0.00 |
| J3490 |
Unclassified drugs |
73 |
57 |
$0.00 |
| 0502F |
|
289 |
248 |
$0.00 |
| 99072 |
|
593 |
544 |
$0.00 |