| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
1,309 |
1,294 |
$108K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,040 |
1,008 |
$62K |
| 62323 |
|
355 |
349 |
$36K |
| 22853 |
|
260 |
147 |
$33K |
| 64493 |
|
323 |
319 |
$30K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
966 |
939 |
$27K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
400 |
386 |
$16K |
| 64494 |
|
323 |
319 |
$15K |
| 22633 |
|
23 |
12 |
$13K |
| 64495 |
|
179 |
178 |
$8K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
33 |
33 |
$2K |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
1,589 |
1,553 |
$2K |
| 20931 |
|
27 |
27 |
$1K |
| 63052 |
|
23 |
12 |
$1K |
| J2704 |
Injection, propofol, 10 mg |
2,873 |
1,501 |
$1K |
| 99215 |
Prolong outpt/office vis |
12 |
12 |
$730.98 |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
1,030 |
992 |
$725.26 |
| 77003 |
|
119 |
118 |
$558.26 |
| J1030 |
Injection, methylprednisolone acetate, 40 mg |
13 |
13 |
$154.08 |
| A4550 |
Surgical trays |
271 |
268 |
$105.00 |
| J1010 |
Injection, methylprednisolone acetate, 1 mg |
15 |
15 |
$92.35 |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
1,323 |
1,287 |
$41.27 |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
1,324 |
1,286 |
$4.08 |
| 20930 |
|
54 |
54 |
$0.00 |
| 99051 |
|
131 |
129 |
$0.00 |
| 99072 |
|
23 |
23 |
$0.00 |
| 20936 |
|
14 |
14 |
$0.00 |