| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| H1001 |
Prenatal care, at-risk enhanced service; antepartum management |
3,016 |
1,681 |
$514K |
| T1001 |
Nursing assessment / evaluation |
2,480 |
1,677 |
$436K |
| 99502 |
|
369 |
296 |
$65K |
| 80053 |
Comprehensive metabolic panel |
880 |
751 |
$56K |
| 36415 |
Collection of venous blood by venipuncture |
641 |
490 |
$53K |
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
659 |
590 |
$35K |
| 99282 |
Emergency department visit for the evaluation and management, low to moderate severity |
233 |
220 |
$33K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
413 |
355 |
$30K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
479 |
416 |
$23K |
| 70553 |
Magnetic resonance imaging, brain; without contrast material, followed by contrast material and further sequences |
32 |
30 |
$18K |
| 86850 |
|
151 |
139 |
$16K |
| 80048 |
Basic metabolic panel (calcium, ionized) |
625 |
512 |
$15K |
| A9552 |
Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries |
16 |
16 |
$14K |
| 71046 |
Radiologic examination, chest; 2 views |
470 |
331 |
$11K |
| 70551 |
Magnetic resonance imaging, brain; without contrast material |
30 |
30 |
$11K |
| 87086 |
Culture, bacterial; quantitative colony count, urine |
433 |
392 |
$10K |
| 97110 |
Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion |
96 |
34 |
$9K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
344 |
215 |
$8K |
| 70450 |
Computed tomography, head or brain; without contrast material |
168 |
149 |
$7K |
| 95782 |
|
17 |
16 |
$7K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
92 |
86 |
$6K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
154 |
145 |
$6K |
| 86900 |
|
160 |
144 |
$6K |
| 82565 |
|
39 |
39 |
$6K |
| 87077 |
|
149 |
135 |
$6K |
| 94760 |
|
87 |
77 |
$5K |
| 96360 |
Intravenous infusion, hydration; initial, 31 minutes to 1 hour |
135 |
115 |
$5K |
| 95810 |
Polysomnography; sleep staging with 4 or more additional parameters |
19 |
17 |
$5K |
| 81003 |
|
278 |
242 |
$5K |
| 85610 |
|
291 |
216 |
$5K |
| 81001 |
|
426 |
372 |
$5K |
| 80307 |
Drug test(s), presumptive, any number of drug classes; immunoassay |
236 |
208 |
$4K |
| 76775 |
|
64 |
62 |
$4K |
| 87070 |
|
111 |
102 |
$4K |
| 87486 |
|
54 |
34 |
$4K |
| 99284 |
Emergency department visit for the evaluation and management, high severity |
477 |
414 |
$4K |
| 95811 |
|
15 |
15 |
$4K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
48 |
46 |
$4K |
| 83655 |
|
71 |
70 |
$3K |
| 93041 |
|
13 |
12 |
$3K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
33 |
32 |
$3K |
| 74018 |
|
82 |
66 |
$2K |
| 96361 |
Intravenous infusion, hydration; each additional hour |
351 |
276 |
$2K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
175 |
114 |
$2K |
| 96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour |
159 |
99 |
$2K |
| 99285 |
Emergency department visit for the evaluation and management, high severity with immediate threat to life |
648 |
561 |
$2K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
35 |
35 |
$2K |
| 85027 |
|
414 |
346 |
$2K |
| 86592 |
|
127 |
119 |
$2K |
| 87081 |
|
86 |
86 |
$1K |
| 76705 |
Ultrasound, abdominal, real time with image documentation; limited |
44 |
41 |
$1K |
| 74230 |
|
14 |
12 |
$1K |
| 93306 |
Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete |
42 |
39 |
$1K |
| 76830 |
Ultrasound, transvaginal |
16 |
16 |
$1K |
| 86140 |
|
121 |
105 |
$1K |
| 74019 |
|
18 |
16 |
$1K |
| 84702 |
|
51 |
42 |
$1K |
| 74022 |
|
39 |
38 |
$1K |
| 80076 |
|
48 |
44 |
$978.86 |
| 73501 |
|
18 |
17 |
$863.63 |
| 74177 |
Computed tomography, abdomen and pelvis; with contrast material |
73 |
70 |
$837.92 |
| G0378 |
Hospital observation service, per hour |
254 |
222 |
$830.68 |
| 76700 |
Ultrasound, abdominal, real time with image documentation; complete |
18 |
17 |
$819.53 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
1,088 |
897 |
$813.18 |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
430 |
337 |
$723.14 |
| 85018 |
|
61 |
44 |
$572.96 |
| 80061 |
Lipid panel |
188 |
174 |
$498.33 |
| 59025 |
Fetal non-stress test |
36 |
30 |
$495.22 |
| C1769 |
Guide wire |
112 |
99 |
$459.27 |
| 71045 |
Radiologic examination, chest; single view |
178 |
161 |
$402.08 |
| 82570 |
|
60 |
57 |
$392.49 |
| 84443 |
Thyroid stimulating hormone (TSH) |
257 |
241 |
$366.36 |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
236 |
147 |
$359.46 |
| 84484 |
|
263 |
205 |
$347.45 |
| 77067 |
Screening mammography, bilateral, including computer-aided detection |
13 |
13 |
$342.56 |
| 82306 |
Vitamin D; 25 hydroxy, includes fraction(s), if performed |
89 |
85 |
$320.78 |
| 72100 |
|
12 |
12 |
$306.13 |
| 80050 |
General health panel |
13 |
13 |
$302.64 |
| 83540 |
|
50 |
45 |
$275.55 |
| 82728 |
|
54 |
49 |
$273.59 |
| 82043 |
|
34 |
32 |
$267.60 |
| 85007 |
|
282 |
226 |
$193.71 |
| 82607 |
|
26 |
25 |
$170.32 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
194 |
179 |
$167.85 |
| 36416 |
|
86 |
55 |
$155.31 |
| 73030 |
|
12 |
12 |
$137.03 |
| 81025 |
|
127 |
119 |
$127.97 |
| 84439 |
|
55 |
50 |
$121.54 |
| 82950 |
|
13 |
13 |
$114.90 |
| 83880 |
|
121 |
97 |
$84.81 |
| 86803 |
|
33 |
32 |
$69.64 |
| 76856 |
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete |
44 |
39 |
$39.88 |
| 82550 |
|
15 |
14 |
$35.81 |
| A9585 |
Injection, gadobutrol, 0.1 ml |
70 |
66 |
$30.63 |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
143 |
135 |
$22.74 |
| 82947 |
|
27 |
16 |
$18.68 |
| 86762 |
|
101 |
94 |
$18.56 |
| 87186 |
|
127 |
110 |
$10.00 |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
249 |
224 |
$8.13 |
| 83735 |
|
223 |
173 |
$6.90 |
| J0131 |
Injection, acetaminophen, not otherwise specified,10 mg |
64 |
54 |
$5.35 |
| 85651 |
|
67 |
63 |
$2.37 |
| 84295 |
|
23 |
15 |
$2.08 |
| J2270 |
Injection, morphine sulfate, up to 10 mg |
91 |
68 |
$1.00 |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
225 |
187 |
$1.00 |
| J0690 |
Injection, cefazolin sodium, 500 mg |
152 |
102 |
$1.00 |
| J1170 |
Injection, hydromorphone, up to 4 mg |
119 |
76 |
$1.00 |
| J1650 |
Injection, enoxaparin sodium, 10 mg |
20 |
13 |
$0.00 |
| J1644 |
Injection, heparin sodium, per 1000 units |
227 |
102 |
$0.00 |
| 82805 |
|
13 |
12 |
$0.00 |
| 87798 |
Infectious agent detection by nucleic acid; not otherwise specified, amplified probe, each organism |
55 |
35 |
$0.00 |
| J3475 |
Injection, magnesium sulfate, per 500 mg |
13 |
12 |
$0.00 |
| C1894 |
Introducer/sheath, other than guiding, other than intracardiac electrophysiological, non-laser |
80 |
68 |
$0.00 |
| C1887 |
Catheter, guiding (may include infusion/perfusion capability) |
20 |
18 |
$0.00 |
| 83721 |
|
14 |
12 |
$0.00 |
| 99152 |
|
55 |
53 |
$0.00 |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
347 |
271 |
$0.00 |
| J2550 |
Injection, promethazine hcl, up to 50 mg |
19 |
14 |
$0.00 |
| 84466 |
|
49 |
44 |
$0.00 |
| Q9966 |
Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml |
39 |
32 |
$0.00 |
| J7040 |
Infusion, normal saline solution, sterile (500 ml = 1 unit) |
53 |
40 |
$0.00 |
| 84156 |
|
15 |
13 |
$0.00 |
| 84145 |
|
36 |
30 |
$0.00 |
| 84100 |
|
78 |
63 |
$0.00 |
| J7030 |
Infusion, normal saline solution , 1000 cc |
401 |
319 |
$0.00 |
| 43239 |
Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple |
40 |
40 |
$0.00 |
| J7120 |
Ringers lactate infusion, up to 1000 cc |
302 |
265 |
$0.00 |
| 85014 |
|
64 |
37 |
$0.00 |
| 88312 |
|
13 |
13 |
$0.00 |
| 85045 |
|
16 |
13 |
$0.00 |
| J1200 |
Injection, diphenhydramine hcl, up to 50 mg |
42 |
37 |
$0.00 |
| 78815 |
Positron emission tomography (PET) for limited area imaging |
16 |
16 |
$0.00 |
| 80164 |
|
14 |
13 |
$0.00 |
| 87633 |
Infectious agent detection by nucleic acid, respiratory virus, 12-25 targets |
54 |
34 |
$0.00 |
| 87581 |
|
55 |
35 |
$0.00 |
| 87040 |
|
95 |
71 |
$0.00 |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
143 |
117 |
$0.00 |
| 83690 |
|
221 |
192 |
$0.00 |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
220 |
194 |
$0.00 |
| 96375 |
Therapeutic injection; each additional sequential IV push |
228 |
167 |
$0.00 |
| 99153 |
Mod sedat endo service >5yrs |
41 |
39 |
$0.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
62 |
60 |
$0.00 |
| 86901 |
|
160 |
144 |
$0.00 |
| J7512 |
Prednisone, immediate release or delayed release, oral, 1 mg |
46 |
31 |
$0.00 |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
179 |
130 |
$0.00 |
| G0480 |
Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 1-7 drug class(es), including metabolite(s) if performed |
18 |
16 |
$0.00 |
| 85730 |
|
76 |
70 |
$0.00 |
| A9270 |
Non-covered item or service |
71 |
33 |
$0.00 |
| J3480 |
Injection, potassium chloride, per 2 meq |
60 |
36 |
$0.00 |
| 87340 |
|
125 |
119 |
$0.00 |
| 84132 |
|
67 |
44 |
$0.00 |
| J0330 |
Injection, succinylcholine chloride, up to 20 mg |
36 |
30 |
$0.00 |
| 90378 |
|
34 |
15 |
$0.00 |
| 83605 |
|
107 |
89 |
$0.00 |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
48 |
46 |
$0.00 |
| J1815 |
Injection, insulin, per 5 units |
31 |
24 |
$0.00 |
| 85379 |
|
35 |
29 |
$0.00 |
| 96374 |
Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance |
361 |
293 |
$0.00 |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
67 |
49 |
$0.00 |
| J3490 |
Unclassified drugs |
186 |
130 |
$0.00 |
| 88305 |
Level IV - Surgical pathology, gross and microscopic examination |
106 |
101 |
$0.00 |
| 71275 |
Computed tomographic angiography, chest, with contrast material |
28 |
26 |
$0.00 |
| 87205 |
|
40 |
34 |
$0.00 |
| 82803 |
|
15 |
14 |
$0.00 |
| 97162 |
|
18 |
15 |
$0.00 |
| 96376 |
|
93 |
64 |
$0.00 |
| J2765 |
Injection, metoclopramide hcl, up to 10 mg |
13 |
12 |
$0.00 |
| 96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; each additional hour |
62 |
40 |
$0.00 |
| C1725 |
Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability) |
22 |
15 |
$0.00 |