| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99285 |
Emergency department visit for the evaluation and management, high severity with immediate threat to life |
22 |
19 |
$33.06 |
| A9270 |
Non-covered item or service |
170 |
28 |
$0.00 |
| 84484 |
|
34 |
17 |
$0.00 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
98 |
62 |
$0.00 |
| 80053 |
Comprehensive metabolic panel |
76 |
49 |
$0.00 |
| 71045 |
Radiologic examination, chest; single view |
20 |
16 |
$0.00 |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
28 |
18 |
$0.00 |
| 85610 |
|
17 |
14 |
$0.00 |