| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
7,529 |
2,203 |
$3.23M |
| 99284 |
Emergency department visit for the evaluation and management, high severity |
12,412 |
9,907 |
$2.09M |
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
10,616 |
8,894 |
$1.44M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
30,370 |
4,244 |
$1.39M |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,589 |
704 |
$1.03M |
| 99285 |
Emergency department visit for the evaluation and management, high severity with immediate threat to life |
5,548 |
4,346 |
$983K |
| 41899 |
Unlisted procedure, dentoalveolar structures |
6,604 |
5,881 |
$778K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
17,746 |
3,830 |
$581K |
| D2934 |
|
5,816 |
1,400 |
$430K |
| D7240 |
Removal of impacted tooth - completely bony |
1,050 |
400 |
$428K |
| G0378 |
Hospital observation service, per hour |
1,341 |
965 |
$368K |
| 96374 |
Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance |
4,816 |
3,698 |
$363K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
8,096 |
6,287 |
$317K |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
7,353 |
6,134 |
$208K |
| 11042 |
Debridement, subcutaneous tissue (includes epidermis, dermis, and subcutaneous tissue); first 20 sq cm |
2,024 |
833 |
$161K |
| 96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour |
2,385 |
1,893 |
$152K |
| D7230 |
|
319 |
143 |
$149K |
| 80307 |
Drug test(s), presumptive, any number of drug classes; immunoassay |
3,871 |
3,159 |
$149K |
| 71045 |
Radiologic examination, chest; single view |
4,419 |
3,481 |
$149K |
| C9803 |
Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
9,676 |
8,208 |
$144K |
| 99282 |
Emergency department visit for the evaluation and management, low to moderate severity |
1,678 |
1,443 |
$141K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,444 |
1,234 |
$134K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
3,516 |
3,081 |
$125K |
| 70450 |
Computed tomography, head or brain; without contrast material |
2,636 |
2,189 |
$120K |
| 74176 |
Computed tomography, abdomen and pelvis; without contrast material |
1,267 |
1,104 |
$113K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
5,180 |
4,227 |
$113K |
| 74177 |
Computed tomography, abdomen and pelvis; with contrast material |
696 |
552 |
$103K |
| 96361 |
Intravenous infusion, hydration; each additional hour |
3,231 |
2,405 |
$103K |
| 96375 |
Therapeutic injection; each additional sequential IV push |
3,786 |
2,844 |
$103K |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
5,890 |
4,597 |
$102K |
| 80053 |
Comprehensive metabolic panel |
15,627 |
11,518 |
$100K |
| 86900 |
|
1,367 |
1,107 |
$86K |
| D2931 |
|
1,173 |
302 |
$78K |
| 97110 |
Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion |
2,284 |
448 |
$75K |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
746 |
506 |
$72K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
15,272 |
11,786 |
$71K |
| 99281 |
Emergency department visit for the evaluation and management, self-limited or minor |
1,469 |
1,305 |
$68K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,488 |
544 |
$57K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
4,375 |
3,745 |
$53K |
| D7250 |
|
309 |
88 |
$46K |
| 96360 |
Intravenous infusion, hydration; initial, 31 minutes to 1 hour |
592 |
461 |
$45K |
| 83880 |
|
2,213 |
1,621 |
$43K |
| 90853 |
Group psychotherapy (other than of a multiple-family group) |
1,057 |
81 |
$43K |
| J0561 |
Injection, penicillin g benzathine, 100,000 units |
370 |
320 |
$42K |
| D0272 |
Bitewings - two radiographic images |
126 |
100 |
$40K |
| 76801 |
|
577 |
489 |
$39K |
| G0481 |
Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 8-14 drug class(es), including metabolite(s) if performed |
609 |
512 |
$38K |
| 86850 |
|
1,243 |
1,009 |
$35K |
| G0480 |
Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 1-7 drug class(es), including metabolite(s) if performed |
658 |
511 |
$34K |
| 71046 |
Radiologic examination, chest; 2 views |
808 |
699 |
$30K |
| 84484 |
|
4,156 |
2,855 |
$29K |
| 82306 |
Vitamin D; 25 hydroxy, includes fraction(s), if performed |
1,436 |
1,245 |
$28K |
| 86901 |
|
1,404 |
1,136 |
$26K |
| 84443 |
Thyroid stimulating hormone (TSH) |
2,321 |
1,969 |
$26K |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
1,492 |
1,295 |
$26K |
| 80061 |
Lipid panel |
2,812 |
2,441 |
$25K |
| 43239 |
Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple |
56 |
52 |
$24K |
| D1120 |
Prophylaxis - child |
2,935 |
2,536 |
$23K |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
334 |
274 |
$23K |
| 87086 |
Culture, bacterial; quantitative colony count, urine |
4,255 |
3,418 |
$22K |
| 84703 |
|
3,864 |
3,236 |
$21K |
| 83735 |
|
5,289 |
3,506 |
$19K |
| D1206 |
Topical application of fluoride varnish |
3,026 |
2,619 |
$18K |
| 85027 |
|
4,566 |
3,372 |
$18K |
| 36600 |
|
486 |
377 |
$16K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
2,449 |
2,124 |
$16K |
| 71250 |
|
389 |
343 |
$15K |
| 80048 |
Basic metabolic panel (calcium, ionized) |
2,753 |
2,035 |
$15K |
| 84702 |
|
1,213 |
932 |
$13K |
| D2750 |
|
149 |
44 |
$13K |
| 74018 |
|
275 |
241 |
$12K |
| D2330 |
|
709 |
276 |
$12K |
| 73030 |
|
302 |
244 |
$12K |
| 81220 |
CFTR (cystic fibrosis transmembrane conductance regulator) gene analysis; common variants |
40 |
28 |
$11K |
| G0463 |
Hospital outpatient clinic visit for assessment and management of a patient |
1,083 |
600 |
$11K |
| 92507 |
Treatment of speech, language, voice, communication, and/or auditory processing disorder |
172 |
53 |
$11K |
| 72125 |
Computed tomography, cervical spine; without contrast material |
245 |
204 |
$11K |
| 81003 |
|
8,253 |
6,585 |
$11K |
| D7241 |
|
24 |
15 |
$10K |
| 97597 |
|
278 |
147 |
$10K |
| J7040 |
Infusion, normal saline solution, sterile (500 ml = 1 unit) |
104 |
94 |
$10K |
| 77067 |
Screening mammography, bilateral, including computer-aided detection |
110 |
106 |
$9K |
| 93041 |
|
719 |
583 |
$9K |
| 87186 |
|
1,373 |
1,143 |
$9K |
| 83690 |
|
2,041 |
1,602 |
$9K |
| 87040 |
|
1,226 |
806 |
$9K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
114 |
101 |
$8K |
| 76856 |
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete |
127 |
111 |
$8K |
| 83605 |
|
1,252 |
934 |
$8K |
| 87807 |
|
724 |
631 |
$8K |
| 82803 |
|
457 |
346 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
36 |
13 |
$7K |
| 86762 |
|
639 |
547 |
$7K |
| 85378 |
|
1,395 |
1,078 |
$6K |
| 96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; each additional hour |
240 |
185 |
$6K |
| 36415 |
Collection of venous blood by venipuncture |
1,090 |
886 |
$6K |
| 59050 |
|
168 |
138 |
$6K |
| 73610 |
|
124 |
109 |
$6K |
| 71047 |
|
166 |
143 |
$5K |
| 86592 |
|
1,655 |
1,446 |
$5K |
| 73560 |
|
140 |
115 |
$5K |
| 73630 |
|
157 |
115 |
$5K |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
53 |
51 |
$5K |
| 87340 |
|
592 |
509 |
$5K |
| 87798 |
Infectious agent detection by nucleic acid; not otherwise specified, amplified probe, each organism |
105 |
51 |
$4K |
| M0243 |
Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring |
19 |
18 |
$4K |
| 87088 |
|
800 |
684 |
$4K |
| 82150 |
|
1,047 |
850 |
$4K |
| D2933 |
|
48 |
12 |
$4K |
| 82962 |
|
2,306 |
1,291 |
$4K |
| 73110 |
|
71 |
46 |
$4K |
| 72148 |
Magnetic resonance imaging, lumbar spine; without contrast material |
48 |
40 |
$4K |
| 83021 |
|
238 |
212 |
$4K |
| 76811 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, detailed |
58 |
55 |
$3K |
| 86318 |
|
317 |
255 |
$3K |
| 73130 |
|
69 |
53 |
$3K |
| 71275 |
Computed tomographic angiography, chest, with contrast material |
45 |
39 |
$3K |
| 81001 |
|
1,081 |
889 |
$2K |
| 82677 |
|
111 |
102 |
$2K |
| D2335 |
|
39 |
13 |
$2K |
| 82728 |
|
217 |
186 |
$2K |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
9,566 |
7,926 |
$2K |
| J3490 |
Unclassified drugs |
4,153 |
2,690 |
$2K |
| 82607 |
|
176 |
146 |
$2K |
| 87070 |
|
270 |
205 |
$2K |
| D1351 |
Sealant - per tooth |
211 |
56 |
$2K |
| 82105 |
|
113 |
104 |
$2K |
| 87350 |
|
140 |
135 |
$2K |
| 86336 |
|
111 |
102 |
$1K |
| 86140 |
|
425 |
337 |
$1K |
| J1200 |
Injection, diphenhydramine hcl, up to 50 mg |
1,154 |
732 |
$1K |
| 82077 |
|
134 |
104 |
$1K |
| 83020 |
|
162 |
130 |
$1K |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
1,759 |
1,419 |
$1K |
| 72131 |
|
30 |
25 |
$1K |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
11,410 |
8,079 |
$1K |
| 85610 |
|
500 |
385 |
$1K |
| 76830 |
Ultrasound, transvaginal |
17 |
14 |
$1K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
48 |
40 |
$1K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
72 |
64 |
$1K |
| 87481 |
|
19 |
18 |
$1K |
| 82950 |
|
220 |
194 |
$945.92 |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
9,191 |
7,313 |
$930.83 |
| 99215 |
Prolong outpt/office vis |
17 |
12 |
$909.09 |
| 87077 |
|
153 |
128 |
$849.91 |
| 86803 |
|
90 |
82 |
$823.19 |
| 87653 |
|
50 |
46 |
$804.07 |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
35 |
28 |
$761.54 |
| 97162 |
|
12 |
12 |
$685.61 |
| 84439 |
|
108 |
93 |
$671.65 |
| 73090 |
|
22 |
12 |
$650.40 |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
2,937 |
2,186 |
$578.71 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
79 |
70 |
$541.50 |
| D9999 |
Unspecified adjunctive procedure, by report |
1,096 |
1,011 |
$521.06 |
| 87500 |
|
35 |
32 |
$451.20 |
| 87493 |
|
15 |
12 |
$376.71 |
| J2704 |
Injection, propofol, 10 mg |
8,252 |
7,003 |
$373.50 |
| 87081 |
|
54 |
54 |
$344.12 |
| 82570 |
|
103 |
95 |
$340.38 |
| 82043 |
|
83 |
79 |
$318.92 |
| 84550 |
|
102 |
85 |
$300.68 |
| J0330 |
Injection, succinylcholine chloride, up to 20 mg |
2,089 |
1,393 |
$217.72 |
| 87641 |
|
29 |
27 |
$190.08 |
| 84100 |
|
80 |
53 |
$169.38 |
| 83550 |
|
26 |
24 |
$158.27 |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
4,982 |
4,058 |
$139.14 |
| 87651 |
Infectious agent detection by nucleic acid; Streptococcus, group A, amplified probe |
15 |
12 |
$105.27 |
| J2270 |
Injection, morphine sulfate, up to 10 mg |
3,872 |
3,339 |
$86.15 |
| 94760 |
|
1,045 |
696 |
$82.39 |
| G0379 |
Direct admission of patient for hospital observation care |
45 |
39 |
$70.05 |
| 83540 |
|
15 |
14 |
$64.02 |
| 85730 |
|
19 |
14 |
$60.00 |
| 82565 |
|
15 |
12 |
$53.32 |
| 87210 |
|
14 |
12 |
$52.40 |
| 85007 |
|
20 |
15 |
$47.88 |
| 85045 |
|
13 |
12 |
$46.67 |
| J2060 |
Injection, lorazepam, 2 mg |
57 |
51 |
$41.35 |
| G2023 |
Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
74 |
65 |
$23.46 |
| J1170 |
Injection, hydromorphone, up to 4 mg |
700 |
335 |
$13.40 |
| 36000 |
|
3,701 |
2,741 |
$12.97 |
| J2919 |
Injection, methylprednisolone sodium succinate, 5 mg |
18 |
14 |
$6.75 |
| J0780 |
Injection, prochlorperazine, up to 10 mg |
207 |
155 |
$0.00 |
| J7120 |
Ringers lactate infusion, up to 1000 cc |
483 |
432 |
$0.00 |
| J2550 |
Injection, promethazine hcl, up to 50 mg |
130 |
98 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
136 |
109 |
$0.00 |
| C9113 |
Injection, pantoprazole sodium, per vial |
130 |
102 |
$0.00 |
| J2930 |
Injection, methylprednisolone sodium succinate, up to 125 mg |
125 |
96 |
$0.00 |
| J1020 |
Injection, methylprednisolone acetate, 20 mg |
134 |
102 |
$0.00 |
| J7510 |
Prednisolone oral, per 5 mg |
166 |
158 |
$0.00 |
| Q0244 |
Injection, casirivimab and imdevimab, 1200 mg |
21 |
19 |
$0.00 |
| 80361 |
|
12 |
12 |
$0.00 |
| J1956 |
Injection, levofloxacin, 250 mg |
87 |
51 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
103 |
68 |
$0.00 |
| 80349 |
|
45 |
41 |
$0.00 |
| 96376 |
|
265 |
178 |
$0.00 |
| J0690 |
Injection, cefazolin sodium, 500 mg |
435 |
234 |
$0.00 |
| J1040 |
Injection, methylprednisolone acetate, 80 mg |
68 |
58 |
$0.00 |
| 80320 |
|
32 |
29 |
$0.00 |
| 94761 |
|
988 |
806 |
$0.00 |
| J2360 |
Injection, orphenadrine citrate, up to 60 mg |
229 |
166 |
$0.00 |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
49 |
37 |
$0.00 |
| J2003 |
Injection, lidocaine hydrochloride, 1 mg |
102 |
98 |
$0.00 |
| 11045 |
|
21 |
12 |
$0.00 |
| J7512 |
Prednisone, immediate release or delayed release, oral, 1 mg |
43 |
40 |
$0.00 |
| J1940 |
Injection, furosemide, up to 20 mg |
65 |
39 |
$0.00 |
| J7050 |
Infusion, normal saline solution, 250 cc |
57 |
57 |
$0.00 |