| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
20 |
19 |
$6K |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
16 |
16 |
$5K |
| D1120 |
Prophylaxis - child |
120 |
117 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
99 |
96 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
115 |
115 |
$2K |
| OP250 |
|
49 |
37 |
$638.24 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
19 |
16 |
$538.17 |
| D0272 |
Bitewings - two radiographic images |
26 |
26 |
$500.64 |
| OP272 |
|
21 |
21 |
$21.04 |
| J3490 |
Unclassified drugs |
23 |
15 |
$13.10 |
| J7120 |
Ringers lactate infusion, up to 1000 cc |
16 |
16 |
$12.97 |
| J8499 |
Prescription drug, oral, non chemotherapeutic, nos |
18 |
16 |
$8.40 |
| J2270 |
Injection, morphine sulfate, up to 10 mg |
15 |
15 |
$5.37 |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
15 |
15 |
$5.33 |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
13 |
13 |
$4.43 |
| OP710 |
|
19 |
19 |
$1.00 |
| OP370 |
|
18 |
18 |
$1.00 |