| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 77067 |
Screening mammography, bilateral, including computer-aided detection |
20 |
20 |
$3K |
| 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 |
58 |
58 |
$2K |
| 76830 |
Ultrasound, transvaginal |
15 |
15 |
$1K |
| 76856 |
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete |
14 |
14 |
$1K |
| 71046 |
Radiologic examination, chest; 2 views |
33 |
33 |
$219.59 |
| 70450 |
Computed tomography, head or brain; without contrast material |
31 |
31 |
$110.43 |
| 80307 |
Drug test(s), presumptive, any number of drug classes; immunoassay |
17 |
15 |
$49.71 |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
60 |
58 |
$8.47 |
| 83690 |
|
16 |
16 |
$0.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
99 |
93 |
$0.00 |
| 83735 |
|
16 |
15 |
$0.00 |
| 80320 |
|
14 |
12 |
$0.00 |
| 80053 |
Comprehensive metabolic panel |
70 |
69 |
$0.00 |
| 84484 |
|
31 |
30 |
$0.00 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
95 |
92 |
$0.00 |
| 84703 |
|
96 |
93 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
22 |
22 |
$0.00 |
| 85730 |
|
14 |
14 |
$0.00 |
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
258 |
240 |
$0.00 |
| 99282 |
Emergency department visit for the evaluation and management, low to moderate severity |
72 |
68 |
$0.00 |
| 81001 |
|
92 |
90 |
$0.00 |
| 71045 |
Radiologic examination, chest; single view |
17 |
17 |
$0.00 |
| 80048 |
Basic metabolic panel (calcium, ionized) |
17 |
17 |
$0.00 |
| 85610 |
|
14 |
14 |
$0.00 |
| 84702 |
|
13 |
13 |
$0.00 |
| 73130 |
|
13 |
13 |
$0.00 |
| 99281 |
Emergency department visit for the evaluation and management, self-limited or minor |
28 |
28 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
12 |
12 |
$0.00 |
| 99284 |
Emergency department visit for the evaluation and management, high severity |
99 |
99 |
$0.00 |
| 73630 |
|
12 |
12 |
$0.00 |
| 82947 |
|
25 |
24 |
$0.00 |