| Code | Description | Claims | Beneficiaries | Total Paid |
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
30,984 |
27,661 |
$5.84M |
| G2067 |
Medication assisted treatment, methadone; weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing, if performed (provision of the services by a medicare-enrolled opioid treatment program) |
25,458 |
8,159 |
$5.04M |
| 90832 |
Psychotherapy, 30 minutes with patient |
33,432 |
21,034 |
$3.99M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
22,820 |
19,869 |
$3.26M |
| 99282 |
Emergency department visit for the evaluation and management, low to moderate severity |
15,208 |
14,080 |
$3.04M |
| 99284 |
Emergency department visit for the evaluation and management, high severity |
16,524 |
15,447 |
$2.78M |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
17,921 |
15,598 |
$2.27M |
| H0020 |
Alcohol and/or drug services; methadone administration and/or service (provision of the drug by a licensed program) |
53,000 |
5,975 |
$1.60M |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
8,280 |
7,516 |
$1.45M |
| 36415 |
Collection of venous blood by venipuncture |
56,563 |
33,321 |
$1.21M |
| 96361 |
Intravenous infusion, hydration; each additional hour |
4,322 |
4,168 |
$1.12M |
| 70450 |
Computed tomography, head or brain; without contrast material |
3,203 |
3,123 |
$844K |
| 90834 |
Psychotherapy, 45 minutes with patient |
5,080 |
3,450 |
$833K |
| 80307 |
Drug test(s), presumptive, any number of drug classes; immunoassay |
21,900 |
10,894 |
$679K |
| 99281 |
Emergency department visit for the evaluation and management, self-limited or minor |
3,313 |
3,167 |
$667K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
12,796 |
11,254 |
$606K |
| 99285 |
Emergency department visit for the evaluation and management, high severity with immediate threat to life |
2,886 |
2,741 |
$494K |
| 80053 |
Comprehensive metabolic panel |
24,354 |
23,205 |
$450K |
| 87798 |
Infectious agent detection by nucleic acid; not otherwise specified, amplified probe, each organism |
5,565 |
5,382 |
$438K |
| G0396 |
Alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes |
4,372 |
3,337 |
$405K |
| 80305 |
|
12,512 |
7,120 |
$377K |
| 96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour |
2,967 |
2,871 |
$370K |
| 76856 |
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete |
845 |
833 |
$290K |
| 99215 |
Prolong outpt/office vis |
1,995 |
1,937 |
$288K |
| 97110 |
Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion |
7,999 |
1,996 |
$266K |
| 96360 |
Intravenous infusion, hydration; initial, 31 minutes to 1 hour |
1,690 |
1,648 |
$261K |
| 90791 |
Psychiatric diagnostic evaluation |
1,327 |
1,002 |
$238K |
| 81025 |
|
6,765 |
6,388 |
$211K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
6,086 |
5,877 |
$210K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
1,717 |
1,474 |
$196K |
| 74177 |
Computed tomography, abdomen and pelvis; with contrast material |
785 |
780 |
$184K |
| G0397 |
Alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., audit, dast), and intervention, greater than 30 minutes |
1,315 |
1,034 |
$183K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
1,666 |
1,538 |
$169K |
| 74176 |
Computed tomography, abdomen and pelvis; without contrast material |
705 |
698 |
$157K |
| 90853 |
Group psychotherapy (other than of a multiple-family group) |
2,061 |
446 |
$157K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,166 |
1,096 |
$151K |
| H0005 |
Alcohol and/or drug services; group counseling by a clinician |
2,026 |
250 |
$146K |
| 97112 |
Therapeutic procedure, each 15 minutes; neuromuscular reeducation of movement, balance, coordination |
4,984 |
1,422 |
$120K |
| 76700 |
Ultrasound, abdominal, real time with image documentation; complete |
275 |
273 |
$109K |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
487 |
468 |
$107K |
| 99442 |
|
1,626 |
1,534 |
$106K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
5,977 |
5,762 |
$97K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
469 |
469 |
$94K |
| 86480 |
|
1,722 |
1,716 |
$91K |
| 99443 |
|
1,183 |
1,135 |
$88K |
| G0463 |
Hospital outpatient clinic visit for assessment and management of a patient |
2,450 |
1,900 |
$88K |
| D0120 |
Periodic oral evaluation - established patient |
2,794 |
2,316 |
$85K |
| 90833 |
Psychotherapy, 30 minutes with patient when performed with an E&M service (add-on) |
1,235 |
1,141 |
$84K |
| 82306 |
Vitamin D; 25 hydroxy, includes fraction(s), if performed |
3,846 |
3,834 |
$84K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
681 |
663 |
$83K |
| 96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; each additional hour |
390 |
387 |
$75K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
708 |
650 |
$70K |
| H2010 |
Comprehensive medication services, per 15 minutes |
684 |
649 |
$60K |
| 82962 |
|
3,552 |
2,879 |
$58K |
| G2077 |
Periodic assessment; assessing periodically by an otp practitioner and includes a review of moud dosing, treatment response, other substance use disorder treatment needs, responses and patient-identified goals, and other relevant physical, nutrition and psychiatric treatment needs and goals; may be informed by administration of a standardized, evidence-based assessment, or the need and interest for harm reduction interventions and recovery support services (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to each primary code |
936 |
311 |
$57K |
| 80061 |
Lipid panel |
5,015 |
4,995 |
$56K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
2,451 |
2,348 |
$55K |
| 96374 |
Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance |
4,597 |
4,419 |
$52K |
| 70486 |
|
529 |
522 |
$48K |
| 99406 |
|
894 |
836 |
$38K |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
1,482 |
1,150 |
$38K |
| D1120 |
Prophylaxis - child |
1,205 |
1,199 |
$38K |
| 76801 |
|
368 |
348 |
$37K |
| 77067 |
Screening mammography, bilateral, including computer-aided detection |
726 |
704 |
$37K |
| 88305 |
Level IV - Surgical pathology, gross and microscopic examination |
739 |
598 |
$36K |
| 86850 |
|
966 |
909 |
$36K |
| 82803 |
|
1,628 |
1,550 |
$36K |
| G2078 |
Take-home supply of methadone; up to 7 additional day supply (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure |
2,156 |
1,370 |
$35K |
| 83880 |
|
1,755 |
1,717 |
$34K |
| 43239 |
Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple |
43 |
43 |
$34K |
| 93306 |
Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete |
267 |
259 |
$33K |
| 86900 |
|
1,643 |
928 |
$32K |
| 86360 |
|
1,019 |
1,018 |
$31K |
| 1033F |
|
2,002 |
383 |
$31K |
| 90732 |
|
731 |
686 |
$30K |
| 71046 |
Radiologic examination, chest; 2 views |
4,965 |
4,860 |
$30K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
324 |
310 |
$28K |
| 90686 |
|
1,172 |
1,146 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
1,055 |
855 |
$27K |
| 90715 |
|
1,143 |
1,138 |
$26K |
| 87661 |
Infectious agent detection by nucleic acid; Trichomonas vaginalis, amplified probe |
817 |
809 |
$23K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
21,558 |
20,536 |
$21K |
| D1110 |
Prophylaxis - adult |
594 |
592 |
$20K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
226 |
213 |
$18K |
| 86901 |
|
986 |
924 |
$18K |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
4,136 |
4,084 |
$18K |
| 97161 |
|
290 |
288 |
$18K |
| 86880 |
|
707 |
691 |
$18K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
119 |
117 |
$16K |
| 88142 |
|
520 |
520 |
$15K |
| D1206 |
Topical application of fluoride varnish |
652 |
651 |
$15K |
| 87536 |
|
800 |
791 |
$15K |
| 90750 |
|
108 |
107 |
$14K |
| 99051 |
|
1,031 |
853 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,446 |
1,416 |
$14K |
| 76641 |
|
360 |
350 |
$13K |
| 80048 |
Basic metabolic panel (calcium, ionized) |
854 |
839 |
$13K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
5,050 |
5,029 |
$13K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
2,360 |
2,298 |
$13K |
| 81001 |
|
10,183 |
6,586 |
$12K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
883 |
840 |
$11K |
| C1725 |
Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability) |
377 |
34 |
$11K |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
8,802 |
8,168 |
$11K |
| 84439 |
|
2,676 |
2,655 |
$11K |
| 99441 |
|
325 |
311 |
$10K |
| 1159F |
|
3,019 |
2,205 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
163 |
135 |
$10K |
| 73130 |
|
720 |
695 |
$9K |
| 87624 |
Infectious agent detection by nucleic acid; human papillomavirus (HPV), high-risk types |
479 |
476 |
$9K |
| 86769 |
|
316 |
295 |
$8K |
| 84443 |
Thyroid stimulating hormone (TSH) |
3,822 |
3,797 |
$8K |
| 12001 |
|
15 |
15 |
$8K |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
1,240 |
1,206 |
$8K |
| 85730 |
|
5,493 |
5,353 |
$8K |
| 1036F |
|
751 |
335 |
$7K |
| 84702 |
|
3,666 |
3,506 |
$7K |
| 71045 |
Radiologic examination, chest; single view |
2,489 |
2,393 |
$7K |
| 92015 |
Determination of refractive state |
519 |
497 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
254 |
216 |
$7K |
| 96375 |
Therapeutic injection; each additional sequential IV push |
3,677 |
3,505 |
$7K |
| 86706 |
|
1,670 |
1,655 |
$7K |
| 72125 |
Computed tomography, cervical spine; without contrast material |
208 |
207 |
$7K |
| 88175 |
Cytopathology, cervical or vaginal, any reporting system; collected in preservative fluid, automated thin layer |
364 |
362 |
$6K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
58 |
55 |
$6K |
| J3490 |
Unclassified drugs |
2,577 |
2,397 |
$6K |
| 96127 |
|
3,467 |
3,301 |
$6K |
| 85610 |
|
4,807 |
4,687 |
$5K |
| J7030 |
Infusion, normal saline solution , 1000 cc |
2,880 |
2,731 |
$5K |
| D0274 |
Bitewings - four radiographic images |
252 |
252 |
$5K |
| 73630 |
|
766 |
730 |
$5K |
| 80074 |
|
383 |
381 |
$5K |
| G0101 |
Cervical or vaginal cancer screening; pelvic and clinical breast examination |
79 |
78 |
$5K |
| 86803 |
|
1,483 |
1,474 |
$4K |
| C9290 |
Injection, bupivacaine liposome, 1 mg |
159 |
146 |
$4K |
| 71250 |
|
53 |
53 |
$4K |
| 10060 |
|
13 |
13 |
$4K |
| 87340 |
|
1,346 |
1,329 |
$4K |
| 1126F |
|
418 |
267 |
$4K |
| 99402 |
|
90 |
83 |
$4K |
| 73560 |
|
486 |
466 |
$3K |
| 85732 |
|
1,008 |
985 |
$3K |
| 92133 |
|
37 |
37 |
$3K |
| 73600 |
|
164 |
163 |
$3K |
| 82607 |
|
643 |
637 |
$3K |
| 82043 |
|
707 |
701 |
$3K |
| 86592 |
|
2,200 |
2,188 |
$3K |
| 81003 |
|
6,786 |
6,593 |
$3K |
| D0272 |
Bitewings - two radiographic images |
197 |
193 |
$3K |
| 72100 |
|
316 |
306 |
$3K |
| U0002 |
2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc |
136 |
127 |
$2K |
| 77063 |
Screening digital breast tomosynthesis, bilateral |
82 |
81 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
89 |
89 |
$2K |
| 1125F |
|
234 |
176 |
$2K |
| 83021 |
|
101 |
101 |
$2K |
| 82728 |
|
559 |
558 |
$2K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
28 |
28 |
$2K |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
6,180 |
5,697 |
$2K |
| 86780 |
|
1,178 |
1,093 |
$2K |
| 86708 |
|
343 |
342 |
$2K |
| 96367 |
|
173 |
167 |
$2K |
| 87070 |
|
221 |
218 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
32 |
29 |
$2K |
| 73030 |
|
274 |
256 |
$2K |
| 83735 |
|
3,933 |
3,776 |
$2K |
| J7050 |
Infusion, normal saline solution, 250 cc |
817 |
767 |
$1K |
| 87088 |
|
329 |
323 |
$1K |
| J2270 |
Injection, morphine sulfate, up to 10 mg |
1,028 |
914 |
$1K |
| 86704 |
|
408 |
406 |
$1K |
| 86701 |
|
174 |
171 |
$1K |
| H0049 |
Alcohol and/or drug screening |
28 |
28 |
$1K |
| 77066 |
Tomosynthesis, mammo |
12 |
12 |
$1K |
| D9310 |
|
38 |
38 |
$1K |
| J0131 |
Injection, acetaminophen, not otherwise specified,10 mg |
237 |
235 |
$1K |
| 73110 |
|
129 |
123 |
$1K |
| 92551 |
|
17 |
12 |
$1K |
| 90677 |
|
12 |
12 |
$1K |
| 82570 |
|
354 |
327 |
$1K |
| 92202 |
|
20 |
20 |
$1K |
| 86705 |
|
357 |
355 |
$1K |
| 86593 |
|
466 |
462 |
$1K |
| J7120 |
Ringers lactate infusion, up to 1000 cc |
874 |
866 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
208 |
174 |
$1K |
| 82552 |
|
1,012 |
985 |
$986.54 |
| 73610 |
|
235 |
225 |
$970.17 |
| 87636 |
Infectious agent detection by nucleic acid; SARS-CoV-2 and influenza virus types A and B |
463 |
460 |
$944.05 |
| J1630 |
Injection, haloperidol, up to 5 mg |
1,403 |
1,286 |
$938.70 |
| J1815 |
Injection, insulin, per 5 units |
48 |
41 |
$932.54 |
| 88141 |
|
70 |
70 |
$887.79 |
| 83690 |
|
4,798 |
4,574 |
$886.90 |
| 83615 |
|
506 |
476 |
$886.77 |
| 87637 |
Infectious agent detection by nucleic acid; SARS-CoV-2, influenza, and RSV |
43 |
43 |
$855.78 |
| 73562 |
|
38 |
38 |
$819.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
302 |
298 |
$815.40 |
| 94060 |
|
12 |
12 |
$805.52 |
| 90756 |
|
71 |
71 |
$787.78 |
| 84100 |
|
609 |
587 |
$769.64 |
| 87522 |
Neg quan hep c or qual rna |
25 |
24 |
$760.18 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
36 |
25 |
$734.86 |
| 83550 |
|
596 |
596 |
$726.37 |
| 82746 |
|
210 |
209 |
$718.07 |
| 99397 |
|
34 |
32 |
$715.91 |
| 90674 |
|
25 |
25 |
$704.81 |
| 84484 |
|
4,428 |
4,085 |
$694.43 |
| 80320 |
|
4,717 |
4,363 |
$685.69 |
| J2001 |
Injection, lidocaine hcl for intravenous infusion, 10 mg |
974 |
877 |
$674.31 |
| J7060 |
5% dextrose/water (500 ml = 1 unit) |
850 |
799 |
$645.41 |
| 84480 |
|
261 |
260 |
$623.94 |
| 83655 |
|
42 |
42 |
$562.28 |
| 84436 |
|
236 |
235 |
$557.97 |
| 90662 |
|
44 |
44 |
$541.19 |
| 85379 |
|
486 |
483 |
$540.17 |
| 92134 |
|
13 |
12 |
$540.00 |
| 11721 |
|
12 |
12 |
$516.04 |
| J2704 |
Injection, propofol, 10 mg |
701 |
687 |
$499.22 |
| G0439 |
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit |
35 |
15 |
$498.57 |
| J1200 |
Injection, diphenhydramine hcl, up to 50 mg |
2,001 |
1,376 |
$441.33 |
| 82550 |
|
453 |
427 |
$440.45 |
| 73590 |
|
27 |
27 |
$427.24 |
| 86707 |
|
53 |
52 |
$419.49 |
| J3475 |
Injection, magnesium sulfate, per 500 mg |
265 |
259 |
$409.75 |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
996 |
975 |
$409.24 |
| 83540 |
|
250 |
245 |
$402.29 |
| J2060 |
Injection, lorazepam, 2 mg |
1,082 |
994 |
$376.18 |
| 73620 |
|
193 |
188 |
$375.64 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
13 |
13 |
$374.26 |
| 86141 |
|
59 |
59 |
$370.90 |
| G0008 |
Administration of influenza virus vaccine |
46 |
46 |
$370.00 |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
2,466 |
2,285 |
$369.06 |
| 85660 |
|
109 |
109 |
$355.50 |
| 81015 |
|
3,861 |
3,754 |
$348.65 |
| J2765 |
Injection, metoclopramide hcl, up to 10 mg |
1,194 |
1,161 |
$345.72 |
| 85651 |
|
283 |
280 |
$333.53 |
| 87086 |
Culture, bacterial; quantitative colony count, urine |
510 |
496 |
$318.02 |
| 85044 |
|
286 |
271 |
$300.72 |
| J1170 |
Injection, hydromorphone, up to 4 mg |
329 |
176 |
$296.49 |
| 76830 |
Ultrasound, transvaginal |
13 |
13 |
$295.74 |
| Q9963 |
High osmolar contrast material, 350-399 mg/ml iodine concentration, per ml |
160 |
156 |
$294.78 |
| 86762 |
|
58 |
54 |
$282.30 |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
728 |
714 |
$279.01 |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$275.04 |
| 83516 |
|
31 |
27 |
$270.88 |
| 86765 |
|
54 |
51 |
$261.96 |
| 90461 |
|
80 |
79 |
$260.82 |
| 90661 |
|
14 |
14 |
$260.54 |
| Q3014 |
Telehealth originating site facility fee |
26 |
24 |
$252.08 |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
612 |
596 |
$229.70 |
| 3008F |
|
1,686 |
1,467 |
$228.03 |
| 87081 |
|
33 |
33 |
$216.38 |
| 85046 |
|
324 |
310 |
$213.06 |
| J0690 |
Injection, cefazolin sodium, 500 mg |
187 |
187 |
$190.04 |
| J8540 |
Dexamethasone, oral, 0.25 mg |
108 |
106 |
$186.36 |
| 87077 |
|
226 |
223 |
$172.98 |
| 82150 |
|
402 |
398 |
$166.85 |
| 3077F |
|
383 |
353 |
$164.89 |
| 3074F |
|
1,111 |
984 |
$164.87 |
| D1208 |
Topical application of fluoride, excluding varnish |
12 |
12 |
$152.40 |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
917 |
880 |
$151.74 |
| J2930 |
Injection, methylprednisolone sodium succinate, up to 125 mg |
213 |
207 |
$139.31 |
| 82948 |
|
1,766 |
1,592 |
$137.90 |
| 87350 |
|
52 |
51 |
$128.97 |
| 80076 |
|
37 |
37 |
$123.44 |
| 72040 |
|
12 |
12 |
$121.20 |
| 83605 |
|
822 |
766 |
$117.42 |
| S0028 |
Injection, famotidine, 20 mg |
93 |
92 |
$95.08 |
| 85652 |
|
74 |
74 |
$94.42 |
| 86140 |
|
120 |
118 |
$73.92 |
| J1953 |
Injection, levetiracetam, 10 mg |
40 |
38 |
$73.16 |
| D9430 |
|
12 |
12 |
$69.08 |
| 84146 |
|
24 |
24 |
$68.87 |
| 73120 |
|
58 |
58 |
$64.20 |
| J1817 |
Insulin for administration through dme (i.e., insulin pump) per 50 units |
17 |
15 |
$62.62 |
| 83001 |
|
12 |
12 |
$62.40 |
| 73501 |
|
25 |
25 |
$61.44 |
| 73502 |
|
24 |
24 |
$55.81 |
| 87040 |
|
681 |
654 |
$55.61 |
| J7613 |
Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg |
737 |
626 |
$52.54 |
| 82248 |
|
163 |
162 |
$51.92 |
| 1160F |
|
1,753 |
1,465 |
$50.00 |
| J2003 |
Injection, lidocaine hydrochloride, 1 mg |
36 |
34 |
$47.79 |
| 82977 |
|
40 |
40 |
$45.10 |
| 87186 |
|
18 |
18 |
$39.54 |
| 86235 |
|
16 |
12 |
$31.50 |
| Q0163 |
Diphenhydramine hydrochloride, 50 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at time of chemotherapy treatment not to exceed a 48 hour dosage regimen |
224 |
214 |
$30.13 |
| 87400 |
|
680 |
677 |
$27.50 |
| 74019 |
|
41 |
40 |
$27.21 |
| 86735 |
|
12 |
12 |
$26.41 |
| J7611 |
Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, 1 mg |
98 |
89 |
$26.38 |
| 88304 |
|
13 |
12 |
$25.33 |
| 86160 |
|
18 |
13 |
$21.22 |
| 84550 |
|
13 |
12 |
$20.12 |
| 73564 |
|
14 |
14 |
$20.00 |
| 96376 |
|
13 |
13 |
$18.59 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
98 |
98 |
$11.25 |
| 86225 |
|
26 |
25 |
$10.50 |
| 74018 |
|
12 |
12 |
$10.00 |
| 73020 |
|
12 |
12 |
$10.00 |
| J0665 |
Injection, bupivicaine, not otherwise specified, 0.5 mg |
14 |
13 |
$6.14 |
| 83930 |
|
119 |
114 |
$6.04 |
| 82009 |
|
157 |
151 |
$5.50 |
| J0687 |
Injection, cefazolin sodium (wg critical care), not therapeutically equivalent to j0690, 500 mg |
13 |
13 |
$5.36 |
| 85007 |
|
232 |
231 |
$4.29 |
| 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 |
164 |
151 |
$2.27 |
| G2089 |
Most recent hemoglobin a1c (hba1c) level 7.0 to 9.0% |
17 |
15 |
$0.13 |
| 3044F |
|
3,518 |
2,958 |
$0.07 |
| 3048F |
|
1,843 |
1,599 |
$0.03 |
| 3050F |
|
638 |
553 |
$0.03 |
| 3079F |
|
484 |
449 |
$0.01 |
| 3049F |
|
944 |
862 |
$0.01 |
| 3080F |
|
213 |
189 |
$0.01 |
| D1330 |
|
1,345 |
1,338 |
$0.00 |
| 3017F |
|
695 |
643 |
$0.00 |
| 1170F |
|
218 |
175 |
$0.00 |
| 3014F |
|
501 |
466 |
$0.00 |
| J3411 |
Injection, thiamine hcl, 100 mg |
133 |
83 |
$0.00 |
| 3075F |
|
327 |
312 |
$0.00 |
| D1310 |
|
1,216 |
1,211 |
$0.00 |
| 3061F |
|
308 |
165 |
$0.00 |
| 85018 |
|
45 |
40 |
$0.00 |
| 4010F |
|
83 |
46 |
$0.00 |
| 4037F |
|
161 |
155 |
$0.00 |
| A9270 |
Non-covered item or service |
94 |
62 |
$0.00 |
| 84478 |
|
14 |
14 |
$0.00 |
| 84132 |
|
14 |
13 |
$0.00 |
| 73090 |
|
12 |
12 |
$0.00 |
| 3725F |
|
713 |
665 |
$0.00 |
| 3078F |
|
1,062 |
953 |
$0.00 |
| J7510 |
Prednisolone oral, per 5 mg |
76 |
62 |
$0.00 |
| 99080 |
|
757 |
174 |
$0.00 |
| 88312 |
|
23 |
13 |
$0.00 |
| 3046F |
|
122 |
112 |
$0.00 |
| Q0091 |
Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory |
33 |
33 |
$0.00 |
| 3062F |
|
190 |
131 |
$0.00 |
| 3045F |
|
37 |
32 |
$0.00 |
| 84156 |
|
13 |
13 |
$0.00 |
| 88302 |
|
12 |
12 |
$0.00 |