| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 42830 |
|
1,841 |
1,569 |
$901K |
| 69436 |
Tympanostomy (requiring insertion of ventilating tube), general anesthesia |
6,029 |
4,843 |
$898K |
| 42820 |
Tonsillectomy and adenoidectomy; younger than age 12 |
2,095 |
1,810 |
$834K |
| 66984 |
Extracapsular cataract removal with insertion of intraocular lens prosthesis |
510 |
322 |
$153K |
| 42825 |
|
25 |
25 |
$17K |
| L8699 |
Prosthetic implant, not otherwise specified |
5,334 |
4,727 |
$2K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
15 |
14 |
$508.68 |
| V2632 |
Posterior chamber intraocular lens |
815 |
484 |
$91.08 |
| 84703 |
|
47 |
38 |
$52.69 |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,807 |
1,650 |
$32.71 |
| 85027 |
|
578 |
333 |
$4.77 |
| 84132 |
|
44 |
24 |
$0.41 |
| 31000 |
|
15 |
15 |
$0.00 |
| 69210 |
|
108 |
26 |
$0.00 |
| J7120 |
Ringers lactate infusion, up to 1000 cc |
76 |
27 |
$0.00 |
| A4649 |
Surgical supply; miscellaneous |
16 |
14 |
$0.00 |
| 84295 |
|
23 |
12 |
$0.00 |
| J3490 |
Unclassified drugs |
179 |
109 |
$0.00 |
| E0191 |
Heel or elbow protector, each |
12 |
12 |
$0.00 |
| 88305 |
Level IV - Surgical pathology, gross and microscopic examination |
72 |
37 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
26 |
12 |
$0.00 |
| 30200 |
|
27 |
24 |
$0.00 |
| A7001 |
Canister, non-disposable, used with suction pump, each |
170 |
165 |
$0.00 |