| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 41899 |
Unlisted procedure, dentoalveolar structures |
370 |
363 |
$107K |
| 93458 |
|
31 |
31 |
$15K |
| C1769 |
Guide wire |
91 |
82 |
$874.23 |
| C1760 |
Closure device, vascular (implantable/insertable) |
16 |
15 |
$575.10 |
| 80053 |
Comprehensive metabolic panel |
87 |
69 |
$383.40 |
| C1887 |
Catheter, guiding (may include infusion/perfusion capability) |
50 |
49 |
$373.05 |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
79 |
74 |
$308.29 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
89 |
70 |
$286.44 |
| C1894 |
Introducer/sheath, other than guiding, other than intracardiac electrophysiological, non-laser |
104 |
77 |
$191.25 |
| 80061 |
Lipid panel |
51 |
47 |
$156.36 |
| 85730 |
|
73 |
64 |
$141.33 |
| 85610 |
|
69 |
64 |
$105.60 |
| 36415 |
Collection of venous blood by venipuncture |
148 |
101 |
$91.00 |
| J1170 |
Injection, hydromorphone, up to 4 mg |
32 |
30 |
$12.00 |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
78 |
70 |
$9.71 |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
89 |
83 |
$5.60 |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
179 |
173 |
$0.00 |
| J7120 |
Ringers lactate infusion, up to 1000 cc |
14 |
12 |
$0.00 |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
156 |
150 |
$0.00 |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
14 |
13 |
$0.00 |