| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 0450 |
Emergency room services |
44,879 |
31,124 |
$2.13M |
| 0300 |
|
29,297 |
9,251 |
$405K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,972 |
738 |
$168K |
| 0636 |
|
6,690 |
2,625 |
$62K |
| 0761 |
|
1,265 |
1,225 |
$44K |
| 0270 |
|
5,360 |
5,114 |
$43K |
| Z9725 |
|
1,316 |
1,311 |
$39K |
| 0360 |
|
274 |
131 |
$31K |
| 0320 |
|
1,113 |
935 |
$22K |
| 0489 |
|
104 |
104 |
$14K |
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
490 |
455 |
$9K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
1,637 |
1,537 |
$9K |
| 0480 |
|
48 |
48 |
$8K |
| A9270 |
Non-covered item or service |
501 |
446 |
$7K |
| 99285 |
Emergency department visit for the evaluation and management, high severity with immediate threat to life |
171 |
160 |
$7K |
| 99284 |
Emergency department visit for the evaluation and management, high severity |
325 |
308 |
$6K |
| 0250 |
|
926 |
687 |
$5K |
| 80053 |
Comprehensive metabolic panel |
964 |
919 |
$5K |
| 96374 |
Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance |
204 |
195 |
$5K |
| 0730 |
|
185 |
183 |
$4K |
| 0310 |
|
122 |
97 |
$4K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
244 |
231 |
$3K |
| 0350 |
|
22 |
14 |
$3K |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
300 |
286 |
$1K |
| 80048 |
Basic metabolic panel (calcium, ionized) |
218 |
207 |
$1K |
| 0012A |
|
34 |
34 |
$1K |
| J3490 |
Unclassified drugs |
40 |
39 |
$1K |
| 96375 |
Therapeutic injection; each additional sequential IV push |
96 |
88 |
$992.35 |
| 0011A |
|
23 |
23 |
$920.00 |
| 99281 |
Emergency department visit for the evaluation and management, self-limited or minor |
12 |
12 |
$744.00 |
| 71046 |
Radiologic examination, chest; 2 views |
109 |
108 |
$491.35 |
| J7030 |
Infusion, normal saline solution , 1000 cc |
205 |
188 |
$479.50 |
| 81001 |
|
147 |
143 |
$340.73 |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
92 |
85 |
$300.80 |
| 81002 |
|
224 |
213 |
$274.84 |
| 71045 |
Radiologic examination, chest; single view |
90 |
83 |
$267.59 |
| 0410 |
|
15 |
14 |
$214.69 |
| 87420 |
|
44 |
38 |
$191.29 |
| 84443 |
Thyroid stimulating hormone (TSH) |
13 |
13 |
$146.77 |
| 80076 |
|
26 |
25 |
$142.27 |
| 96361 |
Intravenous infusion, hydration; each additional hour |
14 |
14 |
$126.33 |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
50 |
49 |
$121.38 |
| 84439 |
|
13 |
13 |
$78.78 |
| 87081 |
|
14 |
14 |
$61.74 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
27 |
27 |
$61.27 |
| 86140 |
|
25 |
25 |
$60.39 |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
83 |
81 |
$29.96 |
| 82962 |
|
36 |
27 |
$25.68 |
| J1170 |
Injection, hydromorphone, up to 4 mg |
16 |
14 |
$20.30 |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
13 |
12 |
$19.04 |
| 88305 |
Level IV - Surgical pathology, gross and microscopic examination |
13 |
12 |
$14.83 |
| 85610 |
|
58 |
56 |
$14.49 |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
107 |
107 |
$5.13 |
| 85730 |
|
13 |
13 |
$4.30 |
| J0690 |
Injection, cefazolin sodium, 500 mg |
12 |
12 |
$0.00 |
| J7120 |
Ringers lactate infusion, up to 1000 cc |
12 |
12 |
$0.00 |