| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J3490 |
Unclassified drugs |
9,658 |
3,886 |
$474K |
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
4,306 |
4,061 |
$318K |
| 99284 |
Emergency department visit for the evaluation and management, high severity |
3,850 |
3,551 |
$247K |
| 99285 |
Emergency department visit for the evaluation and management, high severity with immediate threat to life |
3,259 |
2,918 |
$197K |
| J2270 |
Injection, morphine sulfate, up to 10 mg |
724 |
549 |
$195K |
| 80053 |
Comprehensive metabolic panel |
3,693 |
3,270 |
$193K |
| J0690 |
Injection, cefazolin sodium, 500 mg |
120 |
86 |
$117K |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
316 |
285 |
$111K |
| 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 |
562 |
503 |
$59K |
| 80048 |
Basic metabolic panel (calcium, ionized) |
1,126 |
938 |
$58K |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
632 |
545 |
$57K |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
332 |
309 |
$52K |
| 99282 |
Emergency department visit for the evaluation and management, low to moderate severity |
464 |
428 |
$48K |
| J2765 |
Injection, metoclopramide hcl, up to 10 mg |
207 |
187 |
$36K |
| 71046 |
Radiologic examination, chest; 2 views |
1,835 |
1,694 |
$33K |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
350 |
303 |
$33K |
| 87081 |
|
433 |
414 |
$30K |
| J8540 |
Dexamethasone, oral, 0.25 mg |
262 |
246 |
$28K |
| 81003 |
|
1,507 |
1,346 |
$27K |
| G0463 |
Hospital outpatient clinic visit for assessment and management of a patient |
760 |
630 |
$25K |
| 96361 |
Intravenous infusion, hydration; each additional hour |
595 |
475 |
$24K |
| 84702 |
|
255 |
199 |
$19K |
| 96360 |
Intravenous infusion, hydration; initial, 31 minutes to 1 hour |
168 |
152 |
$18K |
| 81002 |
|
1,088 |
968 |
$17K |
| 87086 |
Culture, bacterial; quantitative colony count, urine |
645 |
582 |
$15K |
| S0028 |
Injection, famotidine, 20 mg |
63 |
60 |
$15K |
| 70450 |
Computed tomography, head or brain; without contrast material |
358 |
318 |
$11K |
| 85027 |
|
2,577 |
2,254 |
$9K |
| G0378 |
Hospital observation service, per hour |
392 |
358 |
$9K |
| 87210 |
|
403 |
363 |
$9K |
| 96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour |
235 |
218 |
$7K |
| 80307 |
Drug test(s), presumptive, any number of drug classes; immunoassay |
256 |
231 |
$5K |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
1,546 |
1,292 |
$5K |
| J2060 |
Injection, lorazepam, 2 mg |
14 |
13 |
$5K |
| 73562 |
|
43 |
40 |
$4K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
451 |
431 |
$4K |
| 76830 |
Ultrasound, transvaginal |
201 |
185 |
$4K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
1,847 |
1,601 |
$3K |
| 81025 |
|
1,122 |
1,012 |
$3K |
| 73130 |
|
29 |
27 |
$3K |
| 96374 |
Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance |
1,810 |
1,554 |
$2K |
| 82962 |
|
425 |
264 |
$2K |
| 73610 |
|
21 |
18 |
$2K |
| 93971 |
|
45 |
42 |
$2K |
| 76705 |
Ultrasound, abdominal, real time with image documentation; limited |
209 |
196 |
$2K |
| 99281 |
Emergency department visit for the evaluation and management, self-limited or minor |
28 |
26 |
$2K |
| 71275 |
Computed tomographic angiography, chest, with contrast material |
160 |
146 |
$2K |
| 73630 |
|
34 |
33 |
$2K |
| S0020 |
Injection, bupivicaine hydrochloride, 30 ml |
69 |
66 |
$2K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
462 |
422 |
$2K |
| J7512 |
Prednisone, immediate release or delayed release, oral, 1 mg |
61 |
49 |
$2K |
| 74177 |
Computed tomography, abdomen and pelvis; with contrast material |
511 |
466 |
$1K |
| 87077 |
|
30 |
25 |
$1K |
| 73030 |
|
26 |
24 |
$1K |
| 84484 |
|
1,165 |
903 |
$1K |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
288 |
247 |
$961.35 |
| 81015 |
|
94 |
88 |
$680.71 |
| 93975 |
|
226 |
207 |
$669.79 |
| 74018 |
|
12 |
12 |
$561.38 |
| 72100 |
|
44 |
39 |
$553.41 |
| 83690 |
|
1,270 |
1,135 |
$537.83 |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
439 |
337 |
$502.50 |
| 83605 |
|
386 |
332 |
$394.75 |
| J1170 |
Injection, hydromorphone, up to 4 mg |
314 |
238 |
$272.41 |
| 74176 |
Computed tomography, abdomen and pelvis; without contrast material |
93 |
83 |
$251.25 |
| 85610 |
|
224 |
196 |
$245.08 |
| 94760 |
|
230 |
177 |
$228.55 |
| 81000 |
|
56 |
54 |
$146.15 |
| 80320 |
|
51 |
41 |
$142.41 |
| 86901 |
|
112 |
102 |
$141.13 |
| 83735 |
|
838 |
704 |
$119.97 |
| 81001 |
|
45 |
42 |
$116.87 |
| 87040 |
|
137 |
123 |
$113.72 |
| 84443 |
Thyroid stimulating hormone (TSH) |
230 |
212 |
$68.72 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
556 |
415 |
$68.43 |
| 82803 |
|
373 |
321 |
$49.44 |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
462 |
422 |
$16.18 |
| 96376 |
|
488 |
340 |
$6.92 |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
734 |
621 |
$5.06 |
| J1200 |
Injection, diphenhydramine hcl, up to 50 mg |
403 |
325 |
$3.35 |
| 96375 |
Therapeutic injection; each additional sequential IV push |
1,198 |
970 |
$2.99 |
| 85018 |
|
13 |
12 |
$0.00 |
| A9270 |
Non-covered item or service |
1,773 |
394 |
$0.00 |
| 94761 |
|
218 |
175 |
$0.00 |
| J2704 |
Injection, propofol, 10 mg |
293 |
267 |
$0.00 |
| 85379 |
|
60 |
56 |
$0.00 |
| 71045 |
Radiologic examination, chest; single view |
30 |
24 |
$0.00 |
| 83880 |
|
388 |
350 |
$0.00 |
| 76801 |
|
62 |
41 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
13 |
13 |
$0.00 |
| 59025 |
Fetal non-stress test |
346 |
265 |
$0.00 |
| 80061 |
Lipid panel |
13 |
12 |
$0.00 |
| 84439 |
|
50 |
42 |
$0.00 |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
1,178 |
980 |
$0.00 |
| 80076 |
|
14 |
12 |
$0.00 |
| J2550 |
Injection, promethazine hcl, up to 50 mg |
78 |
66 |
$0.00 |
| 87186 |
|
60 |
55 |
$0.00 |
| 72125 |
Computed tomography, cervical spine; without contrast material |
32 |
28 |
$0.00 |
| J3475 |
Injection, magnesium sulfate, per 500 mg |
17 |
14 |
$0.00 |
| 90715 |
|
14 |
14 |
$0.00 |
| 86900 |
|
18 |
14 |
$0.00 |
| J2930 |
Injection, methylprednisolone sodium succinate, up to 125 mg |
34 |
27 |
$0.00 |