| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 41899 |
Unlisted procedure, dentoalveolar structures |
399 |
368 |
$1.24M |
| 99284 |
Emergency department visit for the evaluation and management, high severity |
1,281 |
1,125 |
$377K |
| 99285 |
Emergency department visit for the evaluation and management, high severity with immediate threat to life |
779 |
691 |
$306K |
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
914 |
825 |
$147K |
| 99281 |
Emergency department visit for the evaluation and management, self-limited or minor |
2,504 |
2,107 |
$135K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
1,254 |
1,089 |
$47K |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
721 |
617 |
$35K |
| 80053 |
Comprehensive metabolic panel |
996 |
888 |
$28K |
| G0378 |
Hospital observation service, per hour |
40 |
34 |
$23K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
207 |
194 |
$23K |
| 71046 |
Radiologic examination, chest; 2 views |
217 |
200 |
$17K |
| 85730 |
|
360 |
331 |
$16K |
| 71045 |
Radiologic examination, chest; single view |
233 |
200 |
$11K |
| 70450 |
Computed tomography, head or brain; without contrast material |
217 |
196 |
$8K |
| 84484 |
|
331 |
261 |
$6K |
| 80307 |
Drug test(s), presumptive, any number of drug classes; immunoassay |
82 |
77 |
$6K |
| 81001 |
|
413 |
388 |
$5K |
| 85610 |
|
317 |
286 |
$3K |
| 83690 |
|
212 |
201 |
$2K |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
559 |
516 |
$2K |
| 99282 |
Emergency department visit for the evaluation and management, low to moderate severity |
18 |
13 |
$1K |
| 80320 |
|
73 |
63 |
$1K |
| 81003 |
|
219 |
210 |
$1K |
| 82962 |
|
207 |
146 |
$1K |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
35 |
34 |
$946.41 |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
154 |
144 |
$587.06 |
| 74177 |
Computed tomography, abdomen and pelvis; with contrast material |
13 |
13 |
$526.80 |
| 80048 |
Basic metabolic panel (calcium, ionized) |
55 |
45 |
$498.59 |
| 82550 |
|
126 |
110 |
$495.08 |
| 83735 |
|
118 |
95 |
$411.69 |
| 83880 |
|
73 |
61 |
$385.66 |
| 84443 |
Thyroid stimulating hormone (TSH) |
28 |
27 |
$365.49 |
| 82553 |
|
41 |
37 |
$278.60 |
| 80329 |
|
14 |
13 |
$187.12 |
| 94664 |
|
13 |
12 |
$20.21 |
| A9270 |
Non-covered item or service |
573 |
421 |
$0.00 |