| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
28 |
27 |
$683.45 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
13 |
12 |
$613.60 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
14 |
12 |
$508.51 |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
26 |
25 |
$23.20 |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
14 |
14 |
$18.70 |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
28 |
27 |
$18.48 |
| 1159F |
|
79 |
68 |
$0.00 |
| 1160F |
|
77 |
67 |
$0.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
13 |
13 |
$0.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
23 |
13 |
$0.00 |
| 1125F |
|
30 |
28 |
$0.00 |
| 2001F |
|
94 |
83 |
$0.00 |
| 3008F |
|
90 |
81 |
$0.00 |
| 2000F |
|
80 |
71 |
$0.00 |
| 2010F |
|
93 |
83 |
$0.00 |