| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
4,876 |
4,618 |
$337K |
| H1001 |
Prenatal care, at-risk enhanced service; antepartum management |
746 |
446 |
$125K |
| T1001 |
Nursing assessment / evaluation |
510 |
345 |
$86K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
2,078 |
2,046 |
$57K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
498 |
481 |
$52K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
2,912 |
2,847 |
$37K |
| 81025 |
|
4,541 |
4,413 |
$29K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
538 |
524 |
$25K |
| 99501 |
|
230 |
220 |
$20K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
884 |
878 |
$19K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
313 |
311 |
$15K |
| 99201 |
|
433 |
420 |
$12K |
| Q0111 |
Wet mounts, including preparations of vaginal, cervical or skin specimens |
1,817 |
1,745 |
$6K |
| 90716 |
|
40 |
40 |
$5K |
| 11982 |
|
14 |
14 |
$1K |
| 90739 |
|
14 |
14 |
$1K |
| 90715 |
|
64 |
59 |
$1K |
| 90461 |
|
58 |
55 |
$1K |
| J7303 |
Contraceptive supply, hormone containing vaginal ring, each |
14 |
13 |
$357.73 |
| 90661 |
|
18 |
13 |
$340.99 |
| 90674 |
|
13 |
12 |
$280.50 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
63 |
57 |
$212.76 |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
196 |
188 |
$121.79 |
| S4993 |
Contraceptive pills for birth control |
12 |
12 |
$89.23 |
| 90686 |
|
2,250 |
2,211 |
$82.10 |
| 90672 |
|
213 |
203 |
$0.00 |