| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
805 |
312 |
$3K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
128 |
51 |
$486.20 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
64 |
28 |
$329.16 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
509 |
123 |
$210.60 |
| 99051 |
|
248 |
96 |
$71.40 |
| A4208 |
Syringe with needle, sterile 3 cc, each |
90 |
31 |
$0.00 |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
45 |
12 |
$0.00 |
| A4215 |
Needle, sterile, any size, each |
90 |
31 |
$0.00 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
90 |
31 |
$0.00 |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
21 |
12 |
$0.00 |