| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J1569 |
Injection, immune globulin, (gammagard liquid), non-lyophilized, (e.g., liquid), 500 mg |
1,490 |
658 |
$1.68M |
| J1556 |
Injection, immune globulin (bivigam), 500 mg |
65 |
24 |
$171K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,361 |
2,109 |
$113K |
| 96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour |
2,539 |
1,729 |
$65K |
| 96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; each additional hour |
2,489 |
1,705 |
$43K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,018 |
889 |
$31K |
| 96375 |
Therapeutic injection; each additional sequential IV push |
1,009 |
696 |
$15K |
| 95004 |
Percutaneous tests with allergenic extracts, immediate type reaction |
38 |
36 |
$3K |
| 95117 |
|
350 |
213 |
$3K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
29 |
27 |
$2K |
| 96374 |
Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance |
139 |
79 |
$2K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
80 |
53 |
$1K |
| 94010 |
|
14 |
13 |
$272.49 |
| 95012 |
|
15 |
13 |
$144.88 |
| 96160 |
|
55 |
50 |
$127.35 |
| J2930 |
Injection, methylprednisolone sodium succinate, up to 125 mg |
21 |
12 |
$63.67 |
| G8483 |
Influenza immunization was not administered for reasons documented by clinician (e.g., patient allergy or other medical reasons, patient declined or other patient reasons, vaccine not available or other system reasons) |
2,389 |
2,122 |
$0.00 |
| G8482 |
Influenza immunization administered or previously received |
1,468 |
1,248 |
$0.00 |