| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 95165 |
Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy, multiple dose vials |
756 |
161 |
$154K |
| 95004 |
Percutaneous tests with allergenic extracts, immediate type reaction |
146 |
98 |
$30K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
228 |
200 |
$9K |
| 95018 |
|
146 |
98 |
$3K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
44 |
41 |
$3K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
214 |
186 |
$2K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
30 |
29 |
$2K |
| 95076 |
|
39 |
39 |
$2K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
25 |
25 |
$1K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
13 |
13 |
$1K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
247 |
177 |
$470.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
46 |
46 |
$122.10 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
38 |
38 |
$70.73 |
| 90461 |
|
45 |
35 |
$40.00 |
| 97802 |
|
15 |
15 |
$34.89 |
| 90473 |
|
13 |
12 |
$28.00 |
| 99173 |
|
76 |
74 |
$0.00 |
| 97803 |
|
67 |
65 |
$0.00 |
| 90672 |
|
12 |
12 |
$0.00 |
| 90686 |
|
28 |
28 |
$0.00 |
| 90620 |
|
13 |
13 |
$0.00 |