| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J2357 |
Injection, omalizumab, 5 mg |
191 |
142 |
$489K |
| 95004 |
Percutaneous tests with allergenic extracts, immediate type reaction |
838 |
766 |
$308K |
| 95165 |
Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy, multiple dose vials |
761 |
400 |
$235K |
| 96401 |
|
1,995 |
899 |
$133K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,285 |
2,190 |
$88K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
720 |
707 |
$67K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
990 |
961 |
$55K |
| 95117 |
|
5,290 |
2,302 |
$51K |
| 94010 |
|
988 |
958 |
$24K |
| 95012 |
|
1,056 |
1,013 |
$17K |
| 95115 |
|
1,728 |
748 |
$14K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
15 |
15 |
$1K |
| A4617 |
Mouth piece |
1,002 |
963 |
$173.28 |
| J3590 |
Unclassified biologics |
513 |
391 |
$0.00 |