| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 95812 |
|
209 |
209 |
$454K |
| 93325 |
|
247 |
240 |
$319K |
| 42820 |
Tonsillectomy and adenoidectomy; younger than age 12 |
86 |
85 |
$226K |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
571 |
564 |
$214K |
| 94010 |
|
210 |
205 |
$179K |
| 99284 |
Emergency department visit for the evaluation and management, high severity |
360 |
352 |
$151K |
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
740 |
720 |
$136K |
| 69436 |
Tympanostomy (requiring insertion of ventilating tube), general anesthesia |
39 |
39 |
$113K |
| 93306 |
Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete |
47 |
47 |
$56K |
| 96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour |
108 |
99 |
$42K |
| 92567 |
|
435 |
429 |
$39K |
| 93304 |
|
14 |
12 |
$24K |
| OP370 |
|
1,228 |
1,222 |
$19K |
| OP710 |
|
1,227 |
1,218 |
$17K |
| 80053 |
Comprehensive metabolic panel |
621 |
388 |
$16K |
| D1120 |
Prophylaxis - child |
471 |
457 |
$14K |
| 92579 |
|
42 |
42 |
$12K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
1,001 |
797 |
$10K |
| 92555 |
|
119 |
118 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
416 |
401 |
$8K |
| 71046 |
Radiologic examination, chest; 2 views |
176 |
175 |
$6K |
| 93321 |
|
31 |
29 |
$6K |
| 85055 |
|
76 |
47 |
$5K |
| OP272 |
|
1,209 |
1,175 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
189 |
184 |
$3K |
| D0272 |
Bitewings - two radiographic images |
197 |
195 |
$3K |
| 83735 |
|
289 |
180 |
$3K |
| 82977 |
|
228 |
131 |
$3K |
| 88304 |
|
198 |
197 |
$3K |
| 85045 |
|
250 |
240 |
$2K |
| 84100 |
|
310 |
188 |
$2K |
| 83615 |
|
217 |
130 |
$2K |
| D1206 |
Topical application of fluoride varnish |
96 |
96 |
$2K |
| OP270 |
|
395 |
375 |
$2K |
| 84550 |
|
203 |
118 |
$2K |
| 96375 |
Therapeutic injection; each additional sequential IV push |
16 |
13 |
$2K |
| OP250 |
|
1,881 |
1,499 |
$2K |
| 73521 |
|
12 |
12 |
$1K |
| J0131 |
Injection, acetaminophen, not otherwise specified,10 mg |
636 |
618 |
$1K |
| J7050 |
Infusion, normal saline solution, 250 cc |
429 |
288 |
$1K |
| 82248 |
|
115 |
77 |
$1K |
| 85027 |
|
116 |
82 |
$925.90 |
| J7120 |
Ringers lactate infusion, up to 1000 cc |
1,107 |
1,091 |
$435.14 |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
996 |
979 |
$254.65 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$240.00 |
| 85007 |
|
38 |
26 |
$187.46 |
| J2270 |
Injection, morphine sulfate, up to 10 mg |
1,014 |
994 |
$143.78 |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
1,012 |
965 |
$139.80 |
| J2704 |
Injection, propofol, 10 mg |
40 |
39 |
$124.63 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
25 |
24 |
$106.47 |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
84 |
79 |
$34.31 |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
398 |
394 |
$31.95 |
| A9579 |
Injection, gadolinium-based magnetic resonance contrast agent, not otherwise specified (nos), per ml |
12 |
12 |
$31.93 |
| OP259 |
|
501 |
487 |
$26.90 |
| J3490 |
Unclassified drugs |
920 |
437 |
$24.43 |
| J8499 |
Prescription drug, oral, non chemotherapeutic, nos |
729 |
571 |
$17.22 |
| J0690 |
Injection, cefazolin sodium, 500 mg |
133 |
133 |
$16.07 |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
29 |
28 |
$5.57 |
| D1330 |
|
109 |
103 |
$0.00 |