| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| H1000 |
Prenatal care, at-risk assessment |
1,262 |
672 |
$64K |
| 59410 |
|
16 |
16 |
$15K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
141 |
134 |
$15K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
317 |
267 |
$10K |
| 59430 |
|
158 |
151 |
$7K |
| 76830 |
Ultrasound, transvaginal |
161 |
153 |
$7K |
| H1001 |
Prenatal care, at-risk enhanced service; antepartum management |
70 |
67 |
$6K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
132 |
121 |
$3K |
| 99232 |
Subsequent hospital care, per day, moderate complexity |
442 |
68 |
$3K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
82 |
70 |
$2K |
| 99233 |
Prolong inpt eval add15 m |
734 |
62 |
$1K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
15 |
15 |
$967.26 |
| 99223 |
Prolong inpt eval add15 m |
14 |
12 |
$871.82 |
| 76857 |
|
15 |
13 |
$455.84 |
| 93306 |
Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete |
13 |
12 |
$406.45 |
| 99308 |
Subsequent nursing facility care, per day, straightforward |
16 |
12 |
$270.12 |
| 76856 |
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete |
15 |
12 |
$243.76 |
| 81025 |
|
66 |
64 |
$168.32 |
| 99406 |
|
66 |
59 |
$7.49 |
| G8417 |
Bmi is documented above normal parameters and a follow-up plan is documented |
112 |
101 |
$0.00 |
| G8420 |
Bmi is documented within normal parameters and no follow-up plan is required |
53 |
44 |
$0.00 |