| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
4,549 |
3,886 |
$250K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,462 |
2,184 |
$184K |
| J1568 |
Injection, immune globulin, (octagam), intravenous, non-lyophilized (e.g., liquid), 500 mg |
60 |
44 |
$164K |
| 95117 |
|
5,854 |
3,286 |
$62K |
| J2357 |
Injection, omalizumab, 5 mg |
25 |
24 |
$38K |
| 96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour |
686 |
475 |
$26K |
| 96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; each additional hour |
469 |
347 |
$17K |
| 31231 |
|
407 |
331 |
$17K |
| 95115 |
|
1,690 |
969 |
$14K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
124 |
91 |
$13K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
725 |
549 |
$11K |
| 99205 |
Prolong outpt/office vis |
75 |
63 |
$8K |
| 95004 |
Percutaneous tests with allergenic extracts, immediate type reaction |
59 |
53 |
$8K |
| 95165 |
Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy, multiple dose vials |
62 |
45 |
$3K |
| 99215 |
Prolong outpt/office vis |
14 |
14 |
$2K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
55 |
52 |
$2K |
| 94010 |
|
50 |
48 |
$1K |
| 96375 |
Therapeutic injection; each additional sequential IV push |
31 |
26 |
$537.74 |
| J7030 |
Infusion, normal saline solution , 1000 cc |
20 |
12 |
$46.24 |
| 96160 |
|
38 |
34 |
$14.57 |