| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 0360 |
|
95 |
41 |
$121K |
| 0710 |
|
59 |
57 |
$103K |
| 0510 |
|
407 |
362 |
$54K |
| J3490 |
Unclassified drugs |
190 |
71 |
$51K |
| 0450 |
Emergency room services |
28 |
27 |
$45K |
| 80053 |
Comprehensive metabolic panel |
97 |
79 |
$37K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
187 |
149 |
$15K |
| 88189 |
|
46 |
37 |
$4K |
| 83735 |
|
26 |
24 |
$3K |
| J2704 |
Injection, propofol, 10 mg |
38 |
28 |
$2K |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
68 |
52 |
$2K |
| 86900 |
|
30 |
26 |
$2K |
| 85610 |
|
28 |
24 |
$2K |
| 86901 |
|
30 |
26 |
$2K |
| 84460 |
|
26 |
26 |
$1K |
| 85060 |
|
93 |
86 |
$1K |
| 84450 |
|
25 |
25 |
$1K |
| 84165 |
|
488 |
373 |
$1K |
| 85027 |
|
13 |
12 |
$1K |
| 82947 |
|
13 |
12 |
$986.78 |
| G0463 |
Hospital outpatient clinic visit for assessment and management of a patient |
45 |
42 |
$983.44 |
| 86334 |
|
197 |
156 |
$973.05 |
| 93010 |
Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only |
50 |
29 |
$955.20 |
| J8499 |
Prescription drug, oral, non chemotherapeutic, nos |
111 |
38 |
$781.91 |
| 82565 |
|
14 |
14 |
$771.21 |
| 83020 |
|
213 |
176 |
$720.89 |
| 82247 |
|
14 |
14 |
$707.00 |
| 84075 |
|
12 |
12 |
$684.00 |
| 88108 |
|
25 |
12 |
$550.14 |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
46 |
41 |
$460.48 |
| J7030 |
Infusion, normal saline solution , 1000 cc |
15 |
12 |
$320.00 |