| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
301 |
294 |
$134K |
| D0120 |
Periodic oral evaluation - established patient |
184 |
182 |
$69K |
| D1110 |
Prophylaxis - adult |
39 |
39 |
$23K |
| 43239 |
Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple |
12 |
12 |
$2K |
| J2704 |
Injection, propofol, 10 mg |
1,377 |
1,286 |
$48.64 |
| J7120 |
Ringers lactate infusion, up to 1000 cc |
728 |
700 |
$3.32 |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
784 |
726 |
$0.04 |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
532 |
517 |
$0.03 |
| J7040 |
Infusion, normal saline solution, sterile (500 ml = 1 unit) |
258 |
255 |
$0.00 |
| J0134 |
Injection, acetaminophen (fresenius kabi), not therapeutically equivalent to j0131, 10 mg |
86 |
82 |
$0.00 |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
42 |
38 |
$0.00 |
| J0665 |
Injection, bupivicaine, not otherwise specified, 0.5 mg |
110 |
96 |
$0.00 |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
497 |
490 |
$0.00 |
| 88305 |
Level IV - Surgical pathology, gross and microscopic examination |
67 |
67 |
$0.00 |
| J2001 |
Injection, lidocaine hcl for intravenous infusion, 10 mg |
644 |
628 |
$0.00 |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
240 |
237 |
$0.00 |
| J3490 |
Unclassified drugs |
271 |
174 |
$0.00 |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
488 |
406 |
$0.00 |
| J0131 |
Injection, acetaminophen, not otherwise specified,10 mg |
236 |
235 |
$0.00 |
| D7310 |
|
13 |
12 |
$0.00 |
| J2003 |
Injection, lidocaine hydrochloride, 1 mg |
28 |
26 |
$0.00 |
| J0330 |
Injection, succinylcholine chloride, up to 20 mg |
13 |
13 |
$0.00 |