| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99285 |
Emergency department visit for the evaluation and management, high severity with immediate threat to life |
123 |
108 |
$5K |
| 99284 |
Emergency department visit for the evaluation and management, high severity |
164 |
158 |
$4K |
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
213 |
201 |
$4K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
76 |
44 |
$614.68 |
| 70450 |
Computed tomography, head or brain; without contrast material |
12 |
12 |
$443.00 |
| 71045 |
Radiologic examination, chest; single view |
58 |
44 |
$346.37 |
| 93010 |
Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only |
54 |
44 |
$290.09 |
| 80053 |
Comprehensive metabolic panel |
20 |
12 |
$259.88 |
| 71046 |
Radiologic examination, chest; 2 views |
26 |
26 |
$175.75 |
| A0425 |
Ground mileage, per statute mile |
69 |
31 |
$141.53 |
| 93271 |
|
81 |
79 |
$0.00 |
| 93226 |
|
33 |
33 |
$0.00 |