| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
1,232 |
695 |
$62K |
| 99284 |
Emergency department visit for the evaluation and management, high severity |
645 |
364 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
480 |
90 |
$5K |
| 41899 |
Unlisted procedure, dentoalveolar structures |
560 |
315 |
$2K |
| D0272 |
Bitewings - two radiographic images |
71 |
40 |
$1K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,819 |
293 |
$1K |
| D2934 |
|
399 |
70 |
$838.25 |
| 96374 |
Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance |
264 |
143 |
$766.68 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
418 |
221 |
$668.20 |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,982 |
289 |
$632.32 |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
241 |
125 |
$467.97 |
| 99285 |
Emergency department visit for the evaluation and management, high severity with immediate threat to life |
156 |
83 |
$426.05 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
407 |
228 |
$389.20 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
163 |
31 |
$341.60 |
| D0220 |
Intraoral - periapical first radiographic image |
99 |
55 |
$205.27 |
| 96361 |
Intravenous infusion, hydration; each additional hour |
159 |
82 |
$189.84 |
| 96375 |
Therapeutic injection; each additional sequential IV push |
125 |
61 |
$189.84 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
276 |
157 |
$119.04 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
833 |
459 |
$91.94 |
| 71046 |
Radiologic examination, chest; 2 views |
23 |
13 |
$50.72 |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
226 |
123 |
$45.51 |
| 80053 |
Comprehensive metabolic panel |
759 |
411 |
$43.45 |
| 99281 |
Emergency department visit for the evaluation and management, self-limited or minor |
116 |
72 |
$41.77 |
| 80048 |
Basic metabolic panel (calcium, ionized) |
144 |
79 |
$33.84 |
| D1120 |
Prophylaxis - child |
176 |
103 |
$30.12 |
| D1206 |
Topical application of fluoride varnish |
188 |
109 |
$22.42 |
| 87086 |
Culture, bacterial; quantitative colony count, urine |
216 |
126 |
$17.94 |
| 84703 |
|
185 |
107 |
$15.04 |
| 87807 |
|
86 |
51 |
$11.99 |
| 81003 |
|
516 |
294 |
$11.20 |
| 87040 |
|
26 |
12 |
$10.32 |
| J3490 |
Unclassified drugs |
249 |
125 |
$0.22 |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
1,509 |
536 |
$0.00 |
| 96360 |
Intravenous infusion, hydration; initial, 31 minutes to 1 hour |
56 |
30 |
$0.00 |
| 87653 |
|
27 |
15 |
$0.00 |
| 86900 |
|
21 |
15 |
$0.00 |
| 84702 |
|
124 |
71 |
$0.00 |
| 80307 |
Drug test(s), presumptive, any number of drug classes; immunoassay |
179 |
97 |
$0.00 |
| J2270 |
Injection, morphine sulfate, up to 10 mg |
44 |
26 |
$0.00 |
| J7510 |
Prednisolone oral, per 5 mg |
25 |
12 |
$0.00 |
| 70450 |
Computed tomography, head or brain; without contrast material |
33 |
17 |
$0.00 |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
24 |
15 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
19 |
14 |
$0.00 |
| 80061 |
Lipid panel |
59 |
34 |
$0.00 |
| 87186 |
|
23 |
15 |
$0.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
579 |
315 |
$0.00 |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
839 |
474 |
$0.00 |
| J2704 |
Injection, propofol, 10 mg |
750 |
433 |
$0.00 |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
616 |
277 |
$0.00 |
| 84484 |
|
114 |
58 |
$0.00 |
| 71045 |
Radiologic examination, chest; single view |
211 |
111 |
$0.00 |
| 81001 |
|
29 |
16 |
$0.00 |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
43 |
29 |
$0.00 |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
57 |
27 |
$0.00 |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
974 |
465 |
$0.00 |
| 83690 |
|
18 |
12 |
$0.00 |
| 85027 |
|
206 |
127 |
$0.00 |
| J0690 |
Injection, cefazolin sodium, 500 mg |
109 |
41 |
$0.00 |
| 83735 |
|
70 |
34 |
$0.00 |
| J0330 |
Injection, succinylcholine chloride, up to 20 mg |
86 |
35 |
$0.00 |
| 59050 |
|
20 |
13 |
$0.00 |
| 86592 |
|
42 |
29 |
$0.00 |
| 94760 |
|
43 |
24 |
$0.00 |
| 87081 |
|
17 |
12 |
$0.00 |
| 86901 |
|
21 |
15 |
$0.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
23 |
12 |
$0.00 |
| 86850 |
|
18 |
13 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
25 |
12 |
$0.00 |
| 96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour |
27 |
17 |
$0.00 |
| 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 |
36 |
15 |
$0.00 |