| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| H1000 |
Prenatal care, at-risk assessment |
2,757 |
1,156 |
$91K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,193 |
1,198 |
$37K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
883 |
328 |
$14K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
469 |
184 |
$11K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
163 |
63 |
$4K |
| 59430 |
|
65 |
51 |
$3K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
90 |
67 |
$2K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
24 |
24 |
$2K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
13 |
13 |
$1K |
| 81025 |
|
520 |
165 |
$282.18 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
102 |
101 |
$228.76 |
| H1001 |
Prenatal care, at-risk enhanced service; antepartum management |
66 |
13 |
$164.33 |
| 81002 |
|
1,912 |
687 |
$152.48 |
| 81000 |
|
29 |
27 |
$61.75 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
27 |
27 |
$40.00 |
| 3008F |
|
3,159 |
819 |
$0.00 |
| 3014F |
|
298 |
81 |
$0.00 |
| 3351F |
|
4,047 |
1,080 |
$0.00 |
| 1000F |
|
3,821 |
972 |
$0.00 |
| 1036F |
|
357 |
180 |
$0.00 |
| 2010F |
|
94 |
28 |
$0.00 |
| 90651 |
|
13 |
12 |
$0.00 |
| 3015F |
|
2,989 |
752 |
$0.00 |
| 1160F |
|
91 |
16 |
$0.00 |
| 3016F |
|
153 |
54 |
$0.00 |
| 1159F |
|
17 |
16 |
$0.00 |
| 0502F |
|
121 |
59 |
$0.00 |
| 4004F |
|
13 |
12 |
$0.00 |