| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 0450 |
Emergency room services |
2,942 |
2,681 |
$604K |
| 80053 |
Comprehensive metabolic panel |
2,779 |
2,603 |
$275K |
| T1999 |
Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks" |
1,054 |
526 |
$156K |
| Z7502 |
|
2,690 |
2,678 |
$100K |
| 71046 |
Radiologic examination, chest; 2 views |
781 |
763 |
$73K |
| 80048 |
Basic metabolic panel (calcium, ionized) |
440 |
423 |
$50K |
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
2,821 |
2,654 |
$41K |
| 81025 |
|
1,094 |
1,036 |
$38K |
| Z7610 |
|
1,625 |
878 |
$22K |
| J7030 |
Infusion, normal saline solution , 1000 cc |
1,297 |
1,187 |
$18K |
| 99281 |
Emergency department visit for the evaluation and management, self-limited or minor |
474 |
430 |
$17K |
| 70450 |
Computed tomography, head or brain; without contrast material |
404 |
398 |
$16K |
| 71020 |
|
65 |
60 |
$14K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
3,638 |
3,344 |
$12K |
| 36415 |
Collection of venous blood by venipuncture |
1,277 |
1,161 |
$12K |
| 0516 |
|
205 |
197 |
$11K |
| 73610 |
|
85 |
83 |
$10K |
| 99282 |
Emergency department visit for the evaluation and management, low to moderate severity |
976 |
928 |
$9K |
| 0250 |
|
850 |
753 |
$9K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
572 |
557 |
$8K |
| 80306 |
|
313 |
306 |
$8K |
| J3490 |
Unclassified drugs |
3,060 |
1,540 |
$8K |
| 81001 |
|
1,735 |
1,653 |
$7K |
| 99284 |
Emergency department visit for the evaluation and management, high severity |
1,642 |
1,520 |
$7K |
| 96374 |
Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance |
1,060 |
994 |
$6K |
| 74177 |
Computed tomography, abdomen and pelvis; with contrast material |
285 |
283 |
$5K |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
1,684 |
1,282 |
$5K |
| 73630 |
|
92 |
89 |
$5K |
| 96375 |
Therapeutic injection; each additional sequential IV push |
728 |
686 |
$4K |
| 87400 |
|
236 |
233 |
$4K |
| 96361 |
Intravenous infusion, hydration; each additional hour |
893 |
849 |
$4K |
| 74018 |
|
27 |
27 |
$4K |
| 96360 |
Intravenous infusion, hydration; initial, 31 minutes to 1 hour |
207 |
206 |
$3K |
| 96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour |
117 |
100 |
$3K |
| 84702 |
|
319 |
293 |
$3K |
| 74176 |
Computed tomography, abdomen and pelvis; without contrast material |
159 |
155 |
$3K |
| 71045 |
Radiologic examination, chest; single view |
409 |
389 |
$3K |
| G0480 |
Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 1-7 drug class(es), including metabolite(s) if performed |
251 |
237 |
$2K |
| 82962 |
|
355 |
312 |
$2K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
278 |
272 |
$2K |
| 84484 |
|
603 |
539 |
$2K |
| 82553 |
|
302 |
277 |
$1K |
| 87086 |
Culture, bacterial; quantitative colony count, urine |
486 |
470 |
$1K |
| 73110 |
|
12 |
12 |
$1K |
| 87502 |
Infectious agent detection by nucleic acid, influenza virus, for multiple types or subtypes, includes all targets |
283 |
280 |
$993.50 |
| 83690 |
|
1,162 |
1,083 |
$771.65 |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
652 |
621 |
$760.36 |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
347 |
344 |
$750.99 |
| 87077 |
|
192 |
187 |
$728.76 |
| 76705 |
Ultrasound, abdominal, real time with image documentation; limited |
41 |
40 |
$619.54 |
| 87280 |
|
81 |
80 |
$617.68 |
| 81003 |
|
990 |
954 |
$585.32 |
| 99285 |
Emergency department visit for the evaluation and management, high severity with immediate threat to life |
455 |
428 |
$542.20 |
| 82550 |
|
346 |
319 |
$506.09 |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
238 |
209 |
$405.52 |
| 0271 |
|
306 |
300 |
$369.25 |
| G0463 |
Hospital outpatient clinic visit for assessment and management of a patient |
576 |
540 |
$294.41 |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
317 |
304 |
$283.01 |
| 59025 |
Fetal non-stress test |
16 |
13 |
$225.63 |
| 87040 |
|
196 |
189 |
$221.11 |
| 36416 |
|
63 |
60 |
$219.97 |
| 85610 |
|
577 |
544 |
$219.36 |
| 85730 |
|
422 |
405 |
$214.86 |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
647 |
607 |
$211.36 |
| J2270 |
Injection, morphine sulfate, up to 10 mg |
337 |
310 |
$192.72 |
| 0272 |
|
207 |
191 |
$171.98 |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
25 |
25 |
$163.58 |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
25 |
25 |
$163.50 |
| 83735 |
|
301 |
285 |
$162.60 |
| 87186 |
|
172 |
168 |
$158.77 |
| 84443 |
Thyroid stimulating hormone (TSH) |
26 |
25 |
$139.32 |
| 83880 |
|
98 |
92 |
$114.99 |
| 83605 |
|
185 |
178 |
$98.33 |
| J2765 |
Injection, metoclopramide hcl, up to 10 mg |
136 |
132 |
$86.79 |
| 81002 |
|
26 |
26 |
$54.44 |
| J1200 |
Injection, diphenhydramine hcl, up to 50 mg |
42 |
41 |
$35.39 |
| 87651 |
Infectious agent detection by nucleic acid; Streptococcus, group A, amplified probe |
12 |
12 |
$27.73 |
| J2060 |
Injection, lorazepam, 2 mg |
55 |
52 |
$23.55 |
| 86140 |
|
13 |
13 |
$18.39 |
| 86901 |
|
43 |
39 |
$18.19 |
| 86900 |
|
43 |
39 |
$14.23 |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
62 |
61 |
$11.13 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
26 |
26 |
$4.46 |
| 0270 |
|
166 |
98 |
$0.82 |
| A9270 |
Non-covered item or service |
2,404 |
2,171 |
$0.63 |
| G0378 |
Hospital observation service, per hour |
12 |
12 |
$0.00 |
| Q0162 |
Ondansetron 1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen |
369 |
358 |
$0.00 |
| 0258 |
|
14 |
13 |
$0.00 |
| J2001 |
Injection, lidocaine hcl for intravenous infusion, 10 mg |
16 |
16 |
$0.00 |
| 90715 |
|
14 |
14 |
$0.00 |