| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
203 |
193 |
$7K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
92 |
89 |
$3K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
12 |
12 |
$624.00 |
| J3301 |
Injection, triamcinolone acetonide, not otherwise specified, 10 mg |
18 |
16 |
$148.64 |
| J3490 |
Unclassified drugs |
47 |
42 |
$35.00 |
| A4550 |
Surgical trays |
17 |
14 |
$0.00 |