| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A0100 |
Non-emergency transportation; taxi |
2,262 |
576 |
$169K |
| 90960 |
End-stage renal disease related services monthly, for patients 20 years and older, with 4 or more face-to-face visits |
5,316 |
5,272 |
$158K |
| S0215 |
Non-emergency transportation; mileage, per mile |
2,260 |
576 |
$151K |
| 99232 |
Subsequent hospital care, per day, moderate complexity |
13,068 |
3,876 |
$128K |
| 36902 |
|
369 |
350 |
$32K |
| 99233 |
Prolong inpt eval add15 m |
741 |
249 |
$24K |
| 99152 |
|
1,497 |
1,382 |
$6K |
| 99222 |
Initial hospital care, per day, moderate complexity |
170 |
158 |
$6K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
819 |
738 |
$3K |
| 36215 |
|
13 |
13 |
$1K |
| 90935 |
Hemodialysis procedure with single evaluation by a physician |
495 |
212 |
$343.46 |
| 90961 |
|
26 |
26 |
$179.63 |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
1,231 |
1,133 |
$132.48 |
| 75710 |
|
13 |
13 |
$130.18 |
| 99153 |
Mod sedat endo service >5yrs |
242 |
212 |
$124.23 |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
1,235 |
1,135 |
$18.63 |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
2,326 |
1,597 |
$0.00 |
| J1200 |
Injection, diphenhydramine hcl, up to 50 mg |
74 |
67 |
$0.00 |