| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 0450 |
Emergency room services |
27,794 |
19,394 |
$332K |
| 0301 |
|
33,824 |
9,695 |
$70K |
| 0402 |
|
2,251 |
1,793 |
$49K |
| 0300 |
|
6,738 |
6,036 |
$43K |
| 99284 |
Emergency department visit for the evaluation and management, high severity |
823 |
812 |
$18K |
| 0250 |
|
6,103 |
3,730 |
$14K |
| 0305 |
|
11,066 |
7,774 |
$13K |
| 0636 |
|
5,564 |
2,288 |
$8K |
| 80053 |
Comprehensive metabolic panel |
1,070 |
984 |
$8K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
1,211 |
1,084 |
$5K |
| 0241U |
Neonatal screening for hereditary disorders, genomic sequence analysis panel |
32 |
32 |
$4K |
| 0310 |
|
135 |
133 |
$4K |
| 0306 |
|
694 |
421 |
$3K |
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
324 |
300 |
$2K |
| 0302 |
|
243 |
119 |
$2K |
| 0730 |
|
319 |
315 |
$2K |
| 82306 |
Vitamin D; 25 hydroxy, includes fraction(s), if performed |
46 |
45 |
$1K |
| 99285 |
Emergency department visit for the evaluation and management, high severity with immediate threat to life |
181 |
170 |
$1K |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
306 |
291 |
$966.31 |
| 84443 |
Thyroid stimulating hormone (TSH) |
48 |
48 |
$810.48 |
| 0324 |
|
196 |
193 |
$749.67 |
| 80061 |
Lipid panel |
64 |
63 |
$695.87 |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
26 |
26 |
$399.25 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
31 |
31 |
$305.00 |
| 96374 |
Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance |
46 |
43 |
$262.46 |
| 36415 |
Collection of venous blood by venipuncture |
84 |
76 |
$227.07 |
| J3490 |
Unclassified drugs |
105 |
86 |
$225.12 |
| 71045 |
Radiologic examination, chest; single view |
203 |
194 |
$221.98 |
| 84484 |
|
194 |
173 |
$161.46 |
| 71046 |
Radiologic examination, chest; 2 views |
72 |
72 |
$144.11 |
| A9270 |
Non-covered item or service |
543 |
348 |
$139.49 |
| 96375 |
Therapeutic injection; each additional sequential IV push |
32 |
28 |
$87.29 |
| 0307 |
|
254 |
249 |
$83.61 |
| J7030 |
Infusion, normal saline solution , 1000 cc |
67 |
65 |
$44.82 |
| 81001 |
|
115 |
113 |
$42.14 |
| 83690 |
|
74 |
70 |
$38.43 |
| 83880 |
|
28 |
28 |
$24.12 |
| 80048 |
Basic metabolic panel (calcium, ionized) |
46 |
43 |
$6.98 |
| 81003 |
|
12 |
12 |
$1.57 |
| 85610 |
|
58 |
56 |
$0.00 |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
14 |
13 |
$0.00 |
| 80307 |
Drug test(s), presumptive, any number of drug classes; immunoassay |
15 |
13 |
$0.00 |
| 74176 |
Computed tomography, abdomen and pelvis; without contrast material |
12 |
12 |
$0.00 |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
25 |
25 |
$0.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
560 |
342 |
$0.00 |
| 0352 |
|
14 |
12 |
$0.00 |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
13 |
13 |
$0.00 |
| 82962 |
|
16 |
16 |
$0.00 |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
12 |
12 |
$0.00 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
12 |
12 |
$0.00 |
| 83605 |
|
15 |
14 |
$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 |
16 |
14 |
$0.00 |