| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 64636 |
|
54 |
25 |
$44K |
| 64635 |
|
82 |
40 |
$34K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
395 |
248 |
$9K |
| 77002 |
|
119 |
68 |
$3K |
| 20610 |
|
104 |
56 |
$3K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
113 |
54 |
$3K |
| 64493 |
|
18 |
12 |
$2K |
| 64494 |
|
18 |
12 |
$644.00 |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
265 |
163 |
$185.34 |
| 80305 |
|
125 |
52 |
$60.17 |
| J0702 |
Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg |
1,366 |
712 |
$58.13 |
| Q9966 |
Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml |
135 |
79 |
$0.24 |