| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 41899 |
Unlisted procedure, dentoalveolar structures |
15 |
15 |
$26K |
| 99282 |
Emergency department visit for the evaluation and management, low to moderate severity |
13 |
12 |
$2K |
| 36415 |
Collection of venous blood by venipuncture |
27 |
25 |
$92.25 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
26 |
26 |
$70.56 |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
15 |
15 |
$8.64 |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
13 |
13 |
$4.29 |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
15 |
15 |
$1.68 |
| J2704 |
Injection, propofol, 10 mg |
15 |
15 |
$1.44 |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
14 |
14 |
$0.77 |
| 90662 |
|
25 |
25 |
$0.00 |