| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| G0330 |
Facility services for dental rehabilitation procedure(s) performed on a patient who requires monitored anesthesia (e.g., general, intravenous sedation (monitored anesthesia care) and use of an operating room |
274 |
272 |
$39K |
| A0429 |
Ambulance service, basic life support, emergency transport (bls-emergency) |
1,294 |
479 |
$19K |
| J3490 |
Unclassified drugs |
3,503 |
2,190 |
$18K |
| 00170 |
Anesthesia for intraoral procedures, including biopsy |
1,488 |
805 |
$10K |
| 96374 |
Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance |
2,029 |
2,019 |
$7K |
| 96375 |
Therapeutic injection; each additional sequential IV push |
1,655 |
1,618 |
$6K |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
2,025 |
1,978 |
$3K |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
1,813 |
1,778 |
$2K |
| J2175 |
Injection, meperidine hydrochloride, per 100 mg |
638 |
627 |
$2K |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
1,459 |
1,436 |
$2K |
| J2704 |
Injection, propofol, 10 mg |
384 |
375 |
$2K |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
1,938 |
1,896 |
$1K |
| 99221 |
|
14 |
14 |
$1K |
| 96379 |
|
362 |
359 |
$1K |
| 99238 |
Hospital discharge day management, 30 minutes or less |
14 |
14 |
$182.47 |
| J7120 |
Ringers lactate infusion, up to 1000 cc |
322 |
320 |
$6.83 |
| 0710 |
|
1,295 |
1,256 |
$0.00 |
| 0250 |
|
70 |
22 |
$0.00 |
| 0360 |
|
5,275 |
2,136 |
$0.00 |
| J7030 |
Infusion, normal saline solution , 1000 cc |
1,062 |
1,057 |
$0.00 |