| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99285 |
Emergency department visit for the evaluation and management, high severity with immediate threat to life |
3,057 |
791 |
$343K |
| A9270 |
Non-covered item or service |
2,569 |
385 |
$329K |
| J3490 |
Unclassified drugs |
1,095 |
668 |
$236K |
| 99284 |
Emergency department visit for the evaluation and management, high severity |
2,012 |
1,225 |
$197K |
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
1,010 |
782 |
$79K |
| 99282 |
Emergency department visit for the evaluation and management, low to moderate severity |
180 |
168 |
$25K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
564 |
145 |
$23K |
| 00170 |
Anesthesia for intraoral procedures, including biopsy |
90 |
38 |
$18K |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
54 |
41 |
$6K |
| 99291 |
Critical care, evaluation and management of the critically ill patient, first 30-74 minutes |
34 |
12 |
$6K |
| 80053 |
Comprehensive metabolic panel |
102 |
90 |
$2K |
| G0463 |
Hospital outpatient clinic visit for assessment and management of a patient |
49 |
24 |
$2K |
| 69436 |
Tympanostomy (requiring insertion of ventilating tube), general anesthesia |
14 |
12 |
$474.40 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
129 |
117 |
$322.20 |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
17 |
12 |
$0.00 |
| J1010 |
Injection, methylprednisolone acetate, 1 mg |
13 |
12 |
$0.00 |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
26 |
14 |
$0.00 |
| J2704 |
Injection, propofol, 10 mg |
46 |
28 |
$0.00 |