| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
52 |
50 |
$9K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
17 |
17 |
$2K |
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
13 |
13 |
$2K |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
41 |
27 |
$103.48 |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
23 |
19 |
$0.00 |
| J2001 |
Injection, lidocaine hcl for intravenous infusion, 10 mg |
23 |
21 |
$0.00 |
| J0690 |
Injection, cefazolin sodium, 500 mg |
13 |
13 |
$0.00 |
| J2704 |
Injection, propofol, 10 mg |
27 |
25 |
$0.00 |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
16 |
16 |
$0.00 |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
48 |
27 |
$0.00 |