| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| G0463 |
Hospital outpatient clinic visit for assessment and management of a patient |
212,578 |
188,121 |
$28.35M |
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
94,378 |
89,754 |
$15.56M |
| 96361 |
Intravenous infusion, hydration; each additional hour |
12,300 |
10,012 |
$5.26M |
| 42820 |
Tonsillectomy and adenoidectomy; younger than age 12 |
2,896 |
2,862 |
$4.93M |
| 97530 |
Therapeutic activities, direct patient contact, each 15 minutes |
71,435 |
37,945 |
$4.85M |
| 99282 |
Emergency department visit for the evaluation and management, low to moderate severity |
30,008 |
29,203 |
$4.50M |
| 99284 |
Emergency department visit for the evaluation and management, high severity |
30,202 |
28,920 |
$4.15M |
| 69436 |
Tympanostomy (requiring insertion of ventilating tube), general anesthesia |
2,191 |
2,177 |
$2.76M |
| 99285 |
Emergency department visit for the evaluation and management, high severity with immediate threat to life |
23,659 |
22,543 |
$2.51M |
| 44970 |
|
623 |
612 |
$2.43M |
| 92507 |
Treatment of speech, language, voice, communication, and/or auditory processing disorder |
47,698 |
25,155 |
$2.08M |
| 43239 |
Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple |
2,825 |
2,807 |
$1.84M |
| 96360 |
Intravenous infusion, hydration; initial, 31 minutes to 1 hour |
6,988 |
6,764 |
$1.44M |
| 96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour |
7,540 |
6,082 |
$1.27M |
| 95810 |
Polysomnography; sleep staging with 4 or more additional parameters |
1,729 |
1,719 |
$1.25M |
| 70551 |
Magnetic resonance imaging, brain; without contrast material |
3,267 |
3,231 |
$1.06M |
| 42830 |
|
597 |
593 |
$989K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
9,126 |
4,499 |
$988K |
| 92587 |
|
5,646 |
5,489 |
$900K |
| 96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; each additional hour |
2,083 |
1,347 |
$880K |
| 70450 |
Computed tomography, head or brain; without contrast material |
3,281 |
3,204 |
$858K |
| 76705 |
Ultrasound, abdominal, real time with image documentation; limited |
7,584 |
7,116 |
$849K |
| 29085 |
|
2,185 |
2,044 |
$724K |
| 29065 |
|
2,163 |
2,058 |
$719K |
| 54161 |
|
515 |
512 |
$701K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
452 |
441 |
$642K |
| 97803 |
|
19,929 |
18,643 |
$600K |
| 76770 |
|
4,039 |
3,998 |
$592K |
| 12011 |
|
2,276 |
2,229 |
$591K |
| 95782 |
|
695 |
690 |
$532K |
| 95819 |
|
2,147 |
2,129 |
$508K |
| 70553 |
Magnetic resonance imaging, brain; without contrast material, followed by contrast material and further sequences |
1,388 |
1,366 |
$506K |
| 74177 |
Computed tomography, abdomen and pelvis; with contrast material |
1,689 |
1,648 |
$458K |
| J0585 |
Injection, onabotulinumtoxina, 1 unit |
1,034 |
996 |
$453K |
| 97110 |
Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion |
10,683 |
6,107 |
$424K |
| 90378 |
|
1,302 |
1,070 |
$418K |
| 96415 |
|
917 |
748 |
$416K |
| 29075 |
|
1,189 |
1,133 |
$393K |
| 92579 |
|
4,967 |
4,864 |
$388K |
| 80307 |
Drug test(s), presumptive, any number of drug classes; immunoassay |
8,269 |
7,110 |
$382K |
| 12001 |
|
1,390 |
1,370 |
$366K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
7,277 |
7,038 |
$339K |
| G0378 |
Hospital observation service, per hour |
9,529 |
5,463 |
$309K |
| 92567 |
|
13,400 |
13,114 |
$307K |
| 97802 |
|
6,230 |
6,162 |
$269K |
| U0003 |
Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high throughput technologies as described by cms-2020-01-r |
2,723 |
2,620 |
$251K |
| 96413 |
Chemotherapy administration, intravenous infusion; up to 1 hour, single or initial substance |
2,362 |
1,644 |
$232K |
| 76937 |
|
2,467 |
2,292 |
$232K |
| 80053 |
Comprehensive metabolic panel |
33,529 |
29,643 |
$218K |
| 95715 |
|
480 |
434 |
$208K |
| 76856 |
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete |
1,490 |
1,439 |
$194K |
| 95700 |
|
1,263 |
1,232 |
$190K |
| 96450 |
|
459 |
336 |
$175K |
| 20680 |
|
123 |
115 |
$170K |
| 92555 |
|
4,467 |
4,394 |
$169K |
| 54300 |
|
96 |
96 |
$169K |
| 45380 |
Colonoscopy, flexible; with biopsy, single or multiple |
325 |
324 |
$163K |
| 29425 |
|
394 |
318 |
$139K |
| 64643 |
|
519 |
509 |
$139K |
| 43762 |
|
595 |
573 |
$132K |
| 92552 |
|
1,798 |
1,758 |
$129K |
| 87633 |
Infectious agent detection by nucleic acid, respiratory virus, 12-25 targets |
2,945 |
2,900 |
$129K |
| 76536 |
|
1,070 |
1,042 |
$128K |
| 24640 |
|
247 |
241 |
$125K |
| 76885 |
|
955 |
932 |
$120K |
| 76870 |
|
921 |
887 |
$112K |
| 42821 |
|
64 |
64 |
$109K |
| 92585 |
|
384 |
373 |
$102K |
| 54640 |
|
69 |
67 |
$100K |
| 43760 |
|
348 |
334 |
$98K |
| 49452 |
|
155 |
144 |
$95K |
| 64642 |
|
571 |
560 |
$93K |
| 99281 |
Emergency department visit for the evaluation and management, self-limited or minor |
600 |
576 |
$91K |
| 74230 |
|
777 |
766 |
$91K |
| L2275 |
Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined |
730 |
357 |
$91K |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
9,104 |
8,600 |
$86K |
| 17250 |
|
214 |
164 |
$81K |
| 71046 |
Radiologic examination, chest; 2 views |
13,994 |
13,575 |
$81K |
| 74018 |
|
10,745 |
10,021 |
$75K |
| 96367 |
|
702 |
572 |
$73K |
| 51600 |
|
217 |
214 |
$71K |
| 92553 |
|
960 |
942 |
$71K |
| 76942 |
|
511 |
497 |
$68K |
| 76700 |
Ultrasound, abdominal, real time with image documentation; complete |
470 |
466 |
$68K |
| 95812 |
|
154 |
154 |
$66K |
| J1950 |
Injection, leuprolide acetate (for depot suspension), per 3.75 mg |
88 |
87 |
$65K |
| 69210 |
|
1,542 |
1,522 |
$64K |
| 10060 |
|
209 |
206 |
$61K |
| 25605 |
|
103 |
101 |
$59K |
| 24538 |
|
15 |
14 |
$58K |
| 97542 |
|
1,058 |
842 |
$55K |
| 92582 |
|
3,315 |
3,261 |
$54K |
| G0108 |
Diabetes outpatient self-management training services, individual, per 30 minutes |
1,114 |
1,013 |
$50K |
| 97166 |
|
913 |
890 |
$48K |
| 95813 |
|
107 |
107 |
$47K |
| 92526 |
|
996 |
778 |
$46K |
| 92630 |
|
231 |
90 |
$46K |
| 92652 |
|
638 |
628 |
$46K |
| 29105 |
|
227 |
222 |
$44K |
| 87631 |
|
1,687 |
1,666 |
$43K |
| 87040 |
|
4,305 |
4,078 |
$42K |
| 97162 |
|
874 |
853 |
$42K |
| 82784 |
|
4,620 |
4,388 |
$42K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
5,299 |
4,720 |
$39K |
| 92523 |
|
339 |
329 |
$39K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
103 |
98 |
$38K |
| 80048 |
Basic metabolic panel (calcium, ionized) |
5,325 |
4,923 |
$38K |
| 74455 |
|
217 |
214 |
$38K |
| 36415 |
Collection of venous blood by venipuncture |
29,696 |
27,506 |
$38K |
| 95951 |
|
93 |
78 |
$37K |
| 93306 |
Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete |
86 |
86 |
$36K |
| 87505 |
|
591 |
581 |
$36K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
44,072 |
37,693 |
$35K |
| Q5103 |
Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg |
14 |
14 |
$35K |
| 73630 |
|
3,547 |
3,275 |
$34K |
| 36430 |
|
151 |
108 |
$33K |
| Q3014 |
Telehealth originating site facility fee |
1,181 |
1,087 |
$32K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
61 |
59 |
$30K |
| L2840 |
Addition to lower extremity orthosis, tibial length sock, fracture or equal, each |
1,047 |
275 |
$30K |
| 82306 |
Vitamin D; 25 hydroxy, includes fraction(s), if performed |
4,393 |
4,322 |
$29K |
| 99153 |
Mod sedat endo service >5yrs |
7,664 |
7,353 |
$29K |
| 67311 |
|
12 |
12 |
$27K |
| 29405 |
|
80 |
72 |
$26K |
| 80061 |
Lipid panel |
3,086 |
3,034 |
$24K |
| 97535 |
Self-care/home management training, each 15 minutes |
533 |
480 |
$23K |
| 81229 |
|
69 |
68 |
$23K |
| 73610 |
|
4,070 |
3,640 |
$21K |
| 84443 |
Thyroid stimulating hormone (TSH) |
6,964 |
6,845 |
$21K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
1,437 |
1,376 |
$21K |
| 99151 |
|
4,083 |
3,826 |
$20K |
| 72082 |
|
1,850 |
1,786 |
$20K |
| 80050 |
General health panel |
2,414 |
2,376 |
$20K |
| 36592 |
|
19,781 |
17,137 |
$19K |
| 92511 |
|
51 |
47 |
$19K |
| D2390 |
|
27 |
26 |
$19K |
| 95816 |
|
77 |
76 |
$17K |
| 64640 |
|
31 |
25 |
$16K |
| 73502 |
|
2,583 |
2,473 |
$15K |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
6,608 |
6,076 |
$15K |
| 99152 |
|
6,810 |
6,560 |
$15K |
| 73090 |
|
5,321 |
3,911 |
$15K |
| 73590 |
|
3,360 |
2,840 |
$14K |
| 82728 |
|
7,004 |
6,732 |
$14K |
| 73070 |
|
4,805 |
4,021 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
42 |
40 |
$14K |
| 96374 |
Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance |
9,883 |
9,340 |
$14K |
| 84145 |
|
1,778 |
1,723 |
$13K |
| 92611 |
|
707 |
694 |
$13K |
| 73110 |
|
3,465 |
3,008 |
$13K |
| 92557 |
|
173 |
172 |
$13K |
| 73560 |
|
2,339 |
2,096 |
$13K |
| 92610 |
|
264 |
262 |
$13K |
| 92558 |
|
178 |
173 |
$12K |
| 83020 |
|
834 |
797 |
$12K |
| 31575 |
|
37 |
37 |
$11K |
| 71045 |
Radiologic examination, chest; single view |
3,355 |
3,234 |
$11K |
| 80143 |
|
2,007 |
1,845 |
$11K |
| 73130 |
|
2,962 |
2,700 |
$11K |
| 12002 |
|
42 |
42 |
$11K |
| 76882 |
|
102 |
100 |
$10K |
| 94010 |
|
5,691 |
5,615 |
$10K |
| 73140 |
|
2,299 |
2,101 |
$10K |
| 92504 |
|
187 |
178 |
$10K |
| 96138 |
|
23 |
12 |
$10K |
| 84305 |
|
500 |
494 |
$10K |
| 86376 |
|
641 |
633 |
$10K |
| 84439 |
|
4,407 |
4,322 |
$10K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
159 |
154 |
$9K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
9,611 |
9,408 |
$9K |
| 86140 |
|
14,955 |
14,038 |
$9K |
| 88305 |
Level IV - Surgical pathology, gross and microscopic examination |
5,590 |
3,991 |
$8K |
| 77072 |
|
877 |
871 |
$8K |
| 73552 |
|
1,521 |
1,313 |
$8K |
| 97112 |
Therapeutic procedure, each 15 minutes; neuromuscular reeducation of movement, balance, coordination |
260 |
151 |
$8K |
| 84403 |
|
538 |
519 |
$7K |
| 83002 |
|
623 |
574 |
$7K |
| 73721 |
Magnetic resonance imaging, any joint of lower extremity; without contrast material |
26 |
26 |
$7K |
| 83655 |
|
577 |
572 |
$7K |
| 73100 |
|
1,867 |
1,550 |
$7K |
| J0475 |
Injection, baclofen, 10 mg |
13 |
13 |
$7K |
| 72081 |
|
739 |
698 |
$6K |
| 99291 |
Critical care, evaluation and management of the critically ill patient, first 30-74 minutes |
116 |
112 |
$6K |
| 83735 |
|
10,056 |
7,575 |
$6K |
| 16020 |
|
89 |
75 |
$6K |
| 74019 |
|
2,784 |
2,700 |
$6K |
| 87632 |
|
259 |
253 |
$6K |
| 83550 |
|
4,924 |
4,796 |
$6K |
| 80179 |
|
1,928 |
1,814 |
$5K |
| 73000 |
|
1,423 |
1,283 |
$5K |
| 81001 |
|
16,968 |
16,301 |
$5K |
| 25600 |
|
15 |
15 |
$5K |
| 86923 |
|
245 |
171 |
$5K |
| 29345 |
|
13 |
13 |
$5K |
| 87086 |
Culture, bacterial; quantitative colony count, urine |
9,359 |
9,020 |
$5K |
| 87637 |
Infectious agent detection by nucleic acid; SARS-CoV-2, influenza, and RSV |
1,273 |
1,255 |
$5K |
| 96375 |
Therapeutic injection; each additional sequential IV push |
8,001 |
6,217 |
$5K |
| 86665 |
|
970 |
583 |
$5K |
| 70486 |
|
66 |
65 |
$5K |
| 84484 |
|
781 |
737 |
$5K |
| 83540 |
|
5,113 |
4,968 |
$4K |
| J9250 |
Methotrexate sodium, 5 mg |
405 |
313 |
$4K |
| 85652 |
|
8,194 |
7,860 |
$4K |
| 70491 |
|
12 |
12 |
$4K |
| 36591 |
|
4,103 |
2,388 |
$4K |
| 77073 |
|
624 |
607 |
$4K |
| 86364 |
|
2,113 |
2,072 |
$4K |
| 83880 |
|
300 |
277 |
$3K |
| 86738 |
|
257 |
251 |
$3K |
| C1769 |
Guide wire |
1,087 |
997 |
$3K |
| 82248 |
|
8,930 |
6,495 |
$3K |
| L2820 |
Addition to lower extremity orthosis, soft interface for molded plastic, below knee section |
45 |
25 |
$3K |
| 76010 |
|
941 |
888 |
$3K |
| 73562 |
|
486 |
463 |
$3K |
| 87070 |
|
7,161 |
6,916 |
$3K |
| 29125 |
|
24 |
24 |
$3K |
| 74240 |
|
24 |
24 |
$3K |
| 86800 |
|
126 |
125 |
$3K |
| 82570 |
|
2,231 |
2,075 |
$3K |
| 97161 |
|
55 |
54 |
$3K |
| 83690 |
|
7,112 |
6,792 |
$3K |
| 87486 |
|
123 |
122 |
$3K |
| 85027 |
|
1,944 |
1,781 |
$3K |
| 82962 |
|
3,772 |
2,122 |
$3K |
| 81003 |
|
11,967 |
11,404 |
$3K |
| C1713 |
Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable) |
2,056 |
1,912 |
$3K |
| 83615 |
|
8,408 |
6,036 |
$3K |
| 94664 |
|
1,663 |
1,651 |
$3K |
| 83001 |
|
338 |
306 |
$2K |
| 73521 |
|
220 |
212 |
$2K |
| P9040 |
Red blood cells, leukocytes reduced, irradiated, each unit |
18 |
14 |
$2K |
| 70360 |
|
796 |
788 |
$2K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
4,428 |
4,324 |
$2K |
| 80177 |
|
212 |
200 |
$2K |
| 0225U |
|
14,319 |
14,039 |
$2K |
| 87400 |
|
151 |
78 |
$2K |
| 84100 |
|
9,265 |
6,872 |
$2K |
| 80069 |
|
619 |
600 |
$2K |
| 83605 |
|
230 |
224 |
$2K |
| J2704 |
Injection, propofol, 10 mg |
22,553 |
21,476 |
$2K |
| 83516 |
|
2,681 |
1,700 |
$2K |
| J1756 |
Injection, iron sucrose, 1 mg |
74 |
38 |
$2K |
| 84550 |
|
8,721 |
6,376 |
$2K |
| 36416 |
|
7,473 |
6,538 |
$2K |
| 62370 |
|
13 |
13 |
$2K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
321 |
313 |
$2K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
1,444 |
1,384 |
$2K |
| A4649 |
Surgical supply; miscellaneous |
2,459 |
2,306 |
$2K |
| 86003 |
|
451 |
260 |
$2K |
| 76857 |
|
24 |
24 |
$2K |
| 85610 |
|
3,277 |
2,994 |
$2K |
| 83520 |
|
1,785 |
1,320 |
$2K |
| 73030 |
|
344 |
323 |
$2K |
| 87186 |
|
3,752 |
3,563 |
$2K |
| 87798 |
Infectious agent detection by nucleic acid; not otherwise specified, amplified probe, each organism |
167 |
156 |
$2K |
| 86480 |
|
253 |
251 |
$2K |
| 80076 |
|
318 |
310 |
$2K |
| J1642 |
Injection, heparin sodium, (heparin lock flush), per 10 units |
7,277 |
3,254 |
$2K |
| 76800 |
|
12 |
12 |
$2K |
| 91065 |
|
94 |
93 |
$2K |
| 96409 |
|
1,434 |
942 |
$2K |
| 81025 |
|
7,744 |
7,391 |
$2K |
| 73080 |
|
515 |
478 |
$2K |
| 72170 |
|
447 |
428 |
$1K |
| 87581 |
|
123 |
122 |
$1K |
| 0450 |
Emergency room services |
31 |
26 |
$1K |
| 97150 |
Therapeutic procedure(s), group (2 or more individuals) |
168 |
90 |
$1K |
| 85045 |
|
3,465 |
3,083 |
$1K |
| L3995 |
Addition to upper extremity orthosis, sock, fracture or equal, each |
73 |
28 |
$1K |
| 82785 |
|
135 |
133 |
$1K |
| 86235 |
|
185 |
114 |
$1K |
| 82670 |
|
47 |
47 |
$1K |
| 88304 |
|
1,941 |
1,873 |
$1K |
| 96376 |
|
2,679 |
2,027 |
$1K |
| 72040 |
|
145 |
143 |
$1K |
| 82550 |
|
1,327 |
1,244 |
$1K |
| 86850 |
|
2,011 |
1,736 |
$1K |
| 77076 |
|
64 |
51 |
$1K |
| 82607 |
|
432 |
415 |
$1K |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
13,068 |
12,339 |
$1K |
| 85730 |
|
2,813 |
2,656 |
$1K |
| 82977 |
|
1,479 |
1,361 |
$971.93 |
| 87205 |
|
3,886 |
3,674 |
$965.54 |
| 86900 |
|
2,227 |
1,934 |
$912.04 |
| 87077 |
|
2,644 |
2,480 |
$881.96 |
| 82330 |
|
928 |
866 |
$868.30 |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
21,868 |
19,988 |
$832.00 |
| 82077 |
|
1,951 |
1,811 |
$813.43 |
| 86256 |
|
102 |
97 |
$806.90 |
| 73060 |
|
375 |
340 |
$770.85 |
| D1208 |
Topical application of fluoride, excluding varnish |
451 |
441 |
$760.21 |
| 97165 |
|
14 |
13 |
$732.06 |
| B4087 |
Gastrostomy/jejunostomy tube, standard, any material, any type, each |
784 |
727 |
$719.84 |
| 72148 |
Magnetic resonance imaging, lumbar spine; without contrast material |
13 |
13 |
$644.84 |
| 84703 |
|
1,861 |
1,779 |
$610.75 |
| 86901 |
|
2,232 |
1,937 |
$599.76 |
| 81243 |
|
15 |
15 |
$592.06 |
| 72100 |
|
108 |
104 |
$573.55 |
| J2270 |
Injection, morphine sulfate, up to 10 mg |
8,260 |
7,370 |
$551.02 |
| 83013 |
|
43 |
43 |
$540.06 |
| J7120 |
Ringers lactate infusion, up to 1000 cc |
17,272 |
15,613 |
$526.86 |
| 86341 |
|
42 |
38 |
$522.37 |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
3,798 |
3,628 |
$521.01 |
| 88108 |
|
561 |
488 |
$514.29 |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
3,167 |
2,816 |
$510.88 |
| 82247 |
|
288 |
228 |
$510.01 |
| 83970 |
|
42 |
41 |
$499.13 |
| 72125 |
Computed tomography, cervical spine; without contrast material |
12 |
12 |
$494.97 |
| J8540 |
Dexamethasone, oral, 0.25 mg |
17,900 |
11,222 |
$493.35 |
| 83498 |
|
27 |
25 |
$491.56 |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
5,568 |
5,265 |
$473.80 |
| 73660 |
|
56 |
52 |
$464.09 |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
17,443 |
16,797 |
$447.36 |
| 97750 |
|
15 |
15 |
$433.62 |
| 86039 |
|
313 |
303 |
$430.02 |
| 85240 |
|
162 |
141 |
$420.66 |
| 82043 |
|
1,045 |
1,019 |
$395.09 |
| 82681 |
|
110 |
104 |
$388.40 |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
10,973 |
9,278 |
$382.64 |
| 94644 |
|
585 |
574 |
$375.76 |
| 85245 |
|
122 |
99 |
$367.03 |
| D1351 |
Sealant - per tooth |
17 |
17 |
$352.92 |
| 83021 |
|
608 |
329 |
$347.21 |
| 90686 |
|
193 |
190 |
$344.76 |
| A9585 |
Injection, gadobutrol, 0.1 ml |
906 |
877 |
$334.75 |
| 82746 |
|
211 |
200 |
$317.58 |
| 84156 |
|
394 |
366 |
$298.29 |
| D1120 |
Prophylaxis - child |
473 |
463 |
$296.55 |
| J3480 |
Injection, potassium chloride, per 2 meq |
2,457 |
1,981 |
$283.20 |
| 82533 |
|
59 |
53 |
$278.90 |
| 36000 |
|
15 |
13 |
$243.13 |
| 83014 |
|
43 |
43 |
$236.48 |
| V5266 |
Battery for use in hearing device |
50 |
48 |
$234.18 |
| 82150 |
|
495 |
465 |
$216.31 |
| 85246 |
|
126 |
110 |
$199.62 |
| J1200 |
Injection, diphenhydramine hcl, up to 50 mg |
2,143 |
1,702 |
$191.96 |
| D0220 |
Intraoral - periapical first radiographic image |
311 |
305 |
$174.74 |
| 89051 |
|
1,279 |
1,134 |
$168.88 |
| J0690 |
Injection, cefazolin sodium, 500 mg |
6,420 |
5,850 |
$165.50 |
| J1170 |
Injection, hydromorphone, up to 4 mg |
2,121 |
2,047 |
$153.07 |
| 85384 |
|
108 |
102 |
$149.26 |
| 85379 |
|
28 |
25 |
$147.62 |
| 86481 |
|
12 |
12 |
$144.80 |
| 88342 |
|
214 |
211 |
$133.28 |
| 83993 |
|
25 |
25 |
$130.02 |
| U0002 |
2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc |
39 |
37 |
$120.66 |
| J9370 |
Vincristine sulfate, 1 mg |
1,858 |
1,300 |
$120.21 |
| 95012 |
|
1,431 |
1,425 |
$104.96 |
| 82465 |
|
209 |
206 |
$101.56 |
| 86160 |
|
87 |
86 |
$72.41 |
| 81015 |
|
204 |
201 |
$69.02 |
| 85014 |
|
40 |
37 |
$65.88 |
| 86769 |
|
68 |
68 |
$59.60 |
| D0272 |
Bitewings - two radiographic images |
317 |
309 |
$56.39 |
| J2710 |
Injection, neostigmine methylsulfate, up to 0.5 mg |
2,125 |
1,974 |
$54.31 |
| 86308 |
|
375 |
373 |
$51.69 |
| J7042 |
5% dextrose/normal saline (500 ml = 1 unit) |
2,902 |
2,471 |
$48.41 |
| 85007 |
|
170 |
145 |
$43.09 |
| 86706 |
|
40 |
40 |
$39.48 |
| 84132 |
|
52 |
50 |
$38.17 |
| 86803 |
|
14 |
14 |
$34.40 |
| 87529 |
|
54 |
50 |
$27.44 |
| J0330 |
Injection, succinylcholine chloride, up to 20 mg |
407 |
396 |
$27.12 |
| 87340 |
|
14 |
14 |
$27.10 |
| 87045 |
|
16 |
15 |
$27.00 |
| 87636 |
Infectious agent detection by nucleic acid; SARS-CoV-2 and influenza virus types A and B |
76 |
75 |
$23.53 |
| 82270 |
|
17 |
14 |
$22.13 |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
14 |
14 |
$20.26 |
| 87425 |
|
12 |
12 |
$19.62 |
| 87427 |
|
15 |
15 |
$19.61 |
| J2795 |
Injection, ropivacaine hydrochloride, 1 mg |
1,100 |
1,082 |
$17.49 |
| A9579 |
Injection, gadolinium-based magnetic resonance contrast agent, not otherwise specified (nos), per ml |
1,354 |
1,328 |
$16.45 |
| J0665 |
Injection, bupivicaine, not otherwise specified, 0.5 mg |
1,169 |
1,157 |
$16.14 |
| V5264 |
Ear mold/insert, not disposable, any type |
560 |
336 |
$15.56 |
| 86920 |
|
21 |
12 |
$10.59 |
| 87184 |
|
19 |
18 |
$10.23 |
| Q4038 |
Cast supplies, short leg cast, adult (11 years +), fiberglass |
43 |
39 |
$10.19 |
| 83519 |
|
13 |
13 |
$9.81 |
| G0268 |
Removal of impacted cerumen (one or both ears) by physician on same date of service as audiologic function testing |
40 |
40 |
$9.65 |
| J2765 |
Injection, metoclopramide hcl, up to 10 mg |
299 |
286 |
$5.54 |
| Q9958 |
High osmolar contrast material, up to 149 mg/ml iodine concentration, per ml |
216 |
209 |
$5.25 |
| J0780 |
Injection, prochlorperazine, up to 10 mg |
213 |
201 |
$4.53 |
| Q4012 |
Cast supplies, short arm cast, pediatric (0-10 years), fiberglass |
140 |
136 |
$4.06 |
| J1815 |
Injection, insulin, per 5 units |
194 |
65 |
$4.02 |
| 85651 |
|
12 |
12 |
$3.97 |
| J3475 |
Injection, magnesium sulfate, per 500 mg |
104 |
92 |
$3.79 |
| 82010 |
|
39 |
39 |
$2.42 |
| J0134 |
Injection, acetaminophen (fresenius kabi), not therapeutically equivalent to j0131, 10 mg |
478 |
457 |
$2.23 |
| J1596 |
Injection, glycopyrrolate, 0.1 mg |
298 |
296 |
$1.19 |
| J1836 |
Injection, metronidazole, 10 mg |
124 |
116 |
$0.72 |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
407 |
396 |
$0.08 |
| J2370 |
Injection, phenylephrine hcl, up to 1 ml |
150 |
140 |
$0.07 |
| J7060 |
5% dextrose/water (500 ml = 1 unit) |
148 |
116 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
160 |
156 |
$0.00 |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
297 |
276 |
$0.00 |
| J2175 |
Injection, meperidine hydrochloride, per 100 mg |
60 |
59 |
$0.00 |
| 87430 |
|
52 |
52 |
$0.00 |
| 86141 |
|
14 |
14 |
$0.00 |
| J0131 |
Injection, acetaminophen, not otherwise specified,10 mg |
16 |
14 |
$0.00 |
| J2003 |
Injection, lidocaine hydrochloride, 1 mg |
212 |
208 |
$0.00 |
| 96139 |
|
23 |
12 |
$0.00 |
| 92595 |
|
472 |
464 |
$0.00 |
| Q4014 |
Cast supplies, gauntlet cast (includes lower forearm and hand), adult (11 years +), fiberglass |
27 |
26 |
$0.00 |
| J1953 |
Injection, levetiracetam, 10 mg |
30 |
24 |
$0.00 |
| J0171 |
Injection, adrenalin, epinephrine, 0.1 mg |
62 |
59 |
$0.00 |
| J0295 |
Injection, ampicillin sodium/sulbactam sodium, per 1.5 gm |
177 |
127 |
$0.00 |
| J0694 |
Injection, cefoxitin sodium, 1 gm |
320 |
242 |
$0.00 |
| 84295 |
|
43 |
40 |
$0.00 |
| 92594 |
|
25 |
24 |
$0.00 |
| J1171 |
Injection, hydromorphone, 0.1 mg |
57 |
55 |
$0.00 |
| A9577 |
Injection, gadobenate dimeglumine (multihance), per ml |
14 |
13 |
$0.00 |
| G1004 |
Clinical decision support mechanism national decision support company, as defined by the medicare appropriate use criteria program |
376 |
331 |
$0.00 |
| 96401 |
|
54 |
40 |
$0.00 |
| J2919 |
Injection, methylprednisolone sodium succinate, 5 mg |
13 |
12 |
$0.00 |
| J9260 |
Injection, methotrexate sodium, 50 mg |
64 |
49 |
$0.00 |
| C1751 |
Catheter, infusion, inserted peripherally, centrally or midline (other than hemodialysis) |
15 |
15 |
$0.00 |