| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 42820 |
Tonsillectomy and adenoidectomy; younger than age 12 |
38 |
38 |
$94K |
| 43239 |
Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple |
12 |
12 |
$2K |
| 88304 |
|
55 |
54 |
$1K |
| 88305 |
Level IV - Surgical pathology, gross and microscopic examination |
174 |
167 |
$369.90 |
| J2704 |
Injection, propofol, 10 mg |
2,227 |
1,931 |
$289.70 |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
1,772 |
1,330 |
$215.20 |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
1,321 |
1,187 |
$132.34 |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
1,224 |
1,088 |
$124.87 |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
1,262 |
1,146 |
$90.18 |
| J0690 |
Injection, cefazolin sodium, 500 mg |
535 |
413 |
$77.18 |
| J1170 |
Injection, hydromorphone, up to 4 mg |
316 |
234 |
$6.08 |
| J7120 |
Ringers lactate infusion, up to 1000 cc |
585 |
558 |
$0.00 |
| J0665 |
Injection, bupivicaine, not otherwise specified, 0.5 mg |
39 |
39 |
$0.00 |
| J1596 |
Injection, glycopyrrolate, 0.1 mg |
59 |
59 |
$0.00 |
| J1171 |
Injection, hydromorphone, 0.1 mg |
32 |
26 |
$0.00 |
| J2004 |
Injection, lidocaine hcl with epinephrine, 1 mg |
14 |
14 |
$0.00 |
| J2710 |
Injection, neostigmine methylsulfate, up to 0.5 mg |
12 |
12 |
$0.00 |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
329 |
275 |
$0.00 |
| J3490 |
Unclassified drugs |
90 |
75 |
$0.00 |
| J2003 |
Injection, lidocaine hydrochloride, 1 mg |
24 |
24 |
$0.00 |