| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J3490 |
Unclassified drugs |
387 |
218 |
$99K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,124 |
635 |
$43K |
| 99284 |
Emergency department visit for the evaluation and management, high severity |
986 |
229 |
$41K |
| 99285 |
Emergency department visit for the evaluation and management, high severity with immediate threat to life |
753 |
105 |
$32K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,015 |
200 |
$19K |
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
353 |
241 |
$15K |
| 99282 |
Emergency department visit for the evaluation and management, low to moderate severity |
110 |
101 |
$9K |
| 90999 |
Unlisted dialysis procedure, inpatient or outpatient |
771 |
13 |
$6K |
| 87081 |
|
60 |
55 |
$3K |
| 0241U |
Neonatal screening for hereditary disorders, genomic sequence analysis panel |
15 |
15 |
$2K |
| G0463 |
Hospital outpatient clinic visit for assessment and management of a patient |
154 |
61 |
$1K |
| 87502 |
Infectious agent detection by nucleic acid, influenza virus, for multiple types or subtypes, includes all targets |
14 |
13 |
$1K |
| 87651 |
Infectious agent detection by nucleic acid; Streptococcus, group A, amplified probe |
54 |
53 |
$924.05 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
179 |
170 |
$744.38 |
| G0008 |
Administration of influenza virus vaccine |
81 |
14 |
$524.60 |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
12 |
12 |
$493.90 |
| 80053 |
Comprehensive metabolic panel |
58 |
49 |
$469.17 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
87 |
78 |
$358.34 |
| 90853 |
Group psychotherapy (other than of a multiple-family group) |
65 |
33 |
$354.54 |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
12 |
12 |
$255.77 |
| 90863 |
|
13 |
13 |
$227.04 |
| 86140 |
|
12 |
12 |
$0.00 |