| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99215 |
Prolong outpt/office vis |
238 |
92 |
$8K |
| 96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour |
228 |
88 |
$6K |
| 96374 |
Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance |
204 |
76 |
$3K |
| 99152 |
|
175 |
64 |
$3K |
| 96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; each additional hour |
244 |
100 |
$2K |
| 96367 |
|
165 |
63 |
$2K |
| 36410 |
|
227 |
88 |
$1K |
| 96368 |
|
165 |
63 |
$983.87 |
| 96375 |
Therapeutic injection; each additional sequential IV push |
140 |
51 |
$674.09 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
33 |
14 |
$580.06 |
| 93041 |
|
284 |
120 |
$477.21 |
| 99484 |
|
154 |
144 |
$411.68 |
| J3490 |
Unclassified drugs |
260 |
104 |
$178.97 |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
321 |
130 |
$21.58 |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
73 |
24 |
$7.97 |
| J2001 |
Injection, lidocaine hcl for intravenous infusion, 10 mg |
332 |
131 |
$3.19 |
| A4930 |
Gloves, sterile, per pair |
60 |
25 |
$0.24 |
| A4450 |
Tape, non-waterproof, per 18 square inches |
141 |
50 |
$0.06 |
| 99072 |
|
35 |
26 |
$0.00 |