| Code | Description | Claims | Beneficiaries | Total Paid |
| 0450 |
|
19,649 |
17,352 |
$1.38M |
| 97110 |
|
27,559 |
7,911 |
$746K |
| 99199 |
|
9,462 |
7,846 |
$555K |
| 74177 |
|
2,053 |
2,002 |
$513K |
| 80053 |
|
22,321 |
19,868 |
$369K |
| 0250 |
|
19,427 |
8,985 |
$348K |
| 97139 |
|
12,805 |
2,762 |
$343K |
| 96374 |
|
5,531 |
4,909 |
$338K |
| U0003 |
Cov-19 amp prb hgh thruput |
4,185 |
3,971 |
$306K |
| 70450 |
|
2,049 |
1,969 |
$287K |
| 97140 |
|
7,614 |
3,204 |
$252K |
| 97750 |
|
4,418 |
2,991 |
$237K |
| 85025 |
|
21,818 |
18,857 |
$228K |
| 99284 |
|
1,845 |
1,671 |
$212K |
| 87637 |
|
1,317 |
1,290 |
$204K |
| 96365 |
|
3,122 |
1,804 |
$204K |
| 96375 |
|
4,498 |
3,828 |
$188K |
| 99283 |
|
2,689 |
2,463 |
$186K |
| 77067 |
|
1,973 |
1,972 |
$186K |
| 93005 |
|
5,897 |
5,449 |
$161K |
| 84443 |
|
7,070 |
6,928 |
$160K |
| 80307 |
|
2,743 |
2,485 |
$150K |
| 87491 |
|
3,212 |
3,090 |
$142K |
| 87591 |
|
3,203 |
3,083 |
$141K |
| 72125 |
|
522 |
505 |
$114K |
| 93306 |
|
443 |
440 |
$113K |
| 80061 |
|
7,158 |
7,113 |
$112K |
| 87631 |
|
1,543 |
1,513 |
$107K |
| 76830 |
|
1,010 |
988 |
$86K |
| 92507 |
|
1,456 |
842 |
$85K |
| J7030 |
Normal saline solution infus |
7,306 |
5,559 |
$84K |
| 82306 |
|
2,792 |
2,768 |
$77K |
| 71046 |
|
3,019 |
2,924 |
$75K |
| 71045 |
|
3,496 |
3,312 |
$74K |
| 80048 |
|
3,722 |
3,392 |
$73K |
| 76856 |
|
806 |
792 |
$71K |
| 96372 |
|
2,318 |
1,979 |
$69K |
| T1999 |
Noc retail items andsupplies |
4,173 |
2,114 |
$68K |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
2,939 |
2,831 |
$63K |
| 88305 |
|
764 |
599 |
$55K |
| 96361 |
|
1,374 |
1,177 |
$54K |
| 73721 |
|
156 |
155 |
$54K |
| 85027 |
|
5,047 |
4,895 |
$50K |
| 83036 |
|
3,909 |
3,885 |
$49K |
| 77063 |
|
1,957 |
1,956 |
$48K |
| 83690 |
|
4,605 |
4,159 |
$47K |
| 84484 |
|
3,605 |
2,962 |
$46K |
| 84439 |
|
3,276 |
3,228 |
$44K |
| 87086 |
|
4,065 |
3,781 |
$42K |
| 72148 |
|
105 |
105 |
$38K |
| 86803 |
|
1,719 |
1,715 |
$36K |
| 86703 |
|
2,187 |
2,179 |
$35K |
| 76700 |
|
380 |
377 |
$34K |
| 81003 |
|
9,019 |
7,967 |
$31K |
| 99285 |
|
194 |
181 |
$31K |
| 76705 |
|
489 |
479 |
$31K |
| 71260 |
|
120 |
120 |
$30K |
| 73564 |
|
915 |
841 |
$29K |
| 81025 |
|
2,991 |
2,826 |
$27K |
| 73030 |
|
769 |
733 |
$26K |
| 71275 |
|
54 |
52 |
$25K |
| J2405 |
Ondansetron hcl injection |
4,278 |
3,449 |
$25K |
| 97799 |
|
944 |
215 |
$23K |
| Z7502 |
|
812 |
725 |
$23K |
| 83735 |
|
2,153 |
1,923 |
$21K |
| 87186 |
|
1,608 |
1,492 |
$18K |
| 87804 |
|
1,969 |
1,017 |
$18K |
| 73610 |
|
641 |
612 |
$17K |
| 87077 |
|
1,825 |
1,692 |
$17K |
| J3490 |
Drugs unclassified injection |
1,464 |
676 |
$16K |
| J1885 |
Ketorolac tromethamine inj |
3,577 |
2,327 |
$16K |
| 96366 |
|
209 |
153 |
$16K |
| 83605 |
|
1,168 |
976 |
$16K |
| 85610 |
|
3,104 |
2,701 |
$16K |
| J7120 |
Ringers lactate infusion |
778 |
639 |
$15K |
| 86140 |
|
2,015 |
1,956 |
$15K |
| 99281 |
|
345 |
324 |
$15K |
| 97802 |
|
185 |
182 |
$15K |
| 97112 |
|
438 |
193 |
$15K |
| 86592 |
|
1,974 |
1,965 |
$14K |
| 87880 |
|
1,066 |
1,052 |
$14K |
| 94640 |
|
603 |
498 |
$14K |
| 84153 |
|
622 |
610 |
$14K |
| 83880 |
|
478 |
447 |
$13K |
| 86850 |
|
561 |
555 |
$13K |
| 73630 |
|
501 |
452 |
$13K |
| 73110 |
|
409 |
387 |
$12K |
| 70551 |
|
38 |
38 |
$12K |
| 85730 |
|
1,340 |
1,299 |
$11K |
| 87633 |
|
32 |
32 |
$11K |
| J1170 |
Hydromorphone injection |
1,218 |
934 |
$11K |
| 85651 |
|
1,981 |
1,930 |
$10K |
| 86901 |
|
775 |
760 |
$10K |
| 82570 |
|
1,287 |
1,192 |
$10K |
| 73130 |
|
386 |
348 |
$10K |
| 72110 |
|
201 |
199 |
$9K |
| 87340 |
|
528 |
524 |
$9K |
| J1100 |
Dexamethasone sodium phos |
1,484 |
1,035 |
$9K |
| A9270 |
Non-covered item or service |
7,389 |
3,119 |
$8K |
| 87070 |
|
621 |
594 |
$8K |
| 97803 |
|
127 |
118 |
$8K |
| 86900 |
|
699 |
688 |
$7K |
| 70553 |
|
13 |
13 |
$7K |
| 80076 |
|
667 |
653 |
$7K |
| 0370 |
|
25 |
25 |
$7K |
| U0002 |
Covid-19 lab test non-cdc |
117 |
113 |
$7K |
| 96360 |
|
122 |
118 |
$7K |
| 80305 |
|
408 |
390 |
$6K |
| 83540 |
|
728 |
710 |
$6K |
| 83550 |
|
616 |
600 |
$6K |
| 36415 |
|
12,369 |
11,376 |
$6K |
| J3010 |
Fentanyl citrate injection |
1,241 |
901 |
$6K |
| 82607 |
|
553 |
547 |
$5K |
| 82728 |
|
403 |
386 |
$5K |
| 90715 |
|
143 |
139 |
$5K |
| 76642 |
|
93 |
82 |
$5K |
| J0131 |
Inj, acetaminophen (nos) |
142 |
135 |
$5K |
| Z7610 |
|
556 |
268 |
$5K |
| 93971 |
|
44 |
43 |
$5K |
| 83516 |
|
378 |
350 |
$4K |
| 0710 |
|
45 |
44 |
$4K |
| 73221 |
|
12 |
12 |
$4K |
| J2250 |
Inj midazolam hydrochloride |
837 |
509 |
$4K |
| 82043 |
|
484 |
481 |
$4K |
| 87428 |
|
56 |
55 |
$4K |
| 84403 |
|
159 |
157 |
$4K |
| 84702 |
|
361 |
318 |
$3K |
| J1200 |
Diphenhydramine hcl injectio |
552 |
476 |
$3K |
| 86038 |
|
320 |
309 |
$3K |
| 29125 |
|
112 |
109 |
$3K |
| 99282 |
|
77 |
70 |
$3K |
| 87040 |
|
150 |
83 |
$3K |
| 82746 |
|
147 |
147 |
$3K |
| 87220 |
|
382 |
373 |
$3K |
| J2270 |
Morphine sulfate injection |
349 |
313 |
$3K |
| 97165 |
|
54 |
40 |
$3K |
| 84550 |
|
444 |
442 |
$2K |
| 76805 |
|
26 |
26 |
$2K |
| A9579 |
Gad-base mr contrast nos,1ml |
101 |
94 |
$2K |
| 86480 |
|
52 |
52 |
$2K |
| 93017 |
|
37 |
37 |
$2K |
| 72100 |
|
83 |
78 |
$2K |
| 94726 |
|
25 |
25 |
$2K |
| 94729 |
|
26 |
26 |
$2K |
| 87635 |
|
43 |
41 |
$2K |
| 0241U |
|
185 |
179 |
$2K |
| 80074 |
|
31 |
31 |
$2K |
| J7040 |
Normal saline solution infus |
277 |
266 |
$2K |
| 87210 |
|
293 |
285 |
$2K |
| 94060 |
|
27 |
27 |
$2K |
| 72128 |
|
12 |
12 |
$2K |
| 72050 |
|
42 |
42 |
$2K |
| 86762 |
|
90 |
90 |
$2K |
| 76816 |
|
18 |
18 |
$2K |
| 84481 |
|
58 |
58 |
$1K |
| 86376 |
|
143 |
136 |
$1K |
| 82948 |
|
260 |
219 |
$1K |
| J2704 |
Inj, propofol, 10 mg |
136 |
110 |
$1K |
| 74176 |
|
13 |
12 |
$1K |
| 76775 |
|
25 |
24 |
$1K |
| 87486 |
|
26 |
26 |
$1K |
| 87581 |
|
26 |
26 |
$1K |
| J0780 |
Prochlorperazine injection |
77 |
70 |
$1K |
| J2060 |
Lorazepam injection |
190 |
175 |
$975.08 |
| 87807 |
|
93 |
85 |
$962.68 |
| 85379 |
|
76 |
74 |
$954.38 |
| 87081 |
|
100 |
100 |
$928.11 |
| 87430 |
|
64 |
63 |
$895.77 |
| 84402 |
|
40 |
40 |
$840.08 |
| 87798 |
|
18 |
18 |
$785.20 |
| 86160 |
|
77 |
43 |
$684.89 |
| J8597 |
Antiemetic drug oral nos |
1,112 |
1,074 |
$677.44 |
| 29515 |
|
34 |
30 |
$646.07 |
| 99214 |
|
16 |
16 |
$606.82 |
| 87426 |
|
18 |
18 |
$589.29 |
| 99213 |
|
22 |
21 |
$554.18 |
| 81002 |
|
169 |
164 |
$545.34 |
| J1171 |
Inj, hydromorphone, 0.1 mg |
18 |
13 |
$528.27 |
| 86787 |
|
82 |
79 |
$506.00 |
| 94760 |
|
60 |
37 |
$414.40 |
| J0696 |
Ceftriaxone sodium injection |
58 |
40 |
$402.93 |
| 72070 |
|
13 |
13 |
$389.82 |
| 86704 |
|
13 |
13 |
$381.24 |
| 86235 |
|
19 |
13 |
$335.29 |
| 86141 |
|
29 |
29 |
$319.39 |
| 0258 |
|
286 |
77 |
$288.35 |
| 97161 |
|
27 |
27 |
$279.28 |
| J2765 |
Metoclopramide hcl injection |
49 |
40 |
$278.24 |
| 86677 |
|
13 |
13 |
$255.18 |
| 45378 |
|
12 |
12 |
$254.16 |
| 0270 |
|
28 |
27 |
$237.79 |
| 82784 |
|
29 |
26 |
$222.17 |
| 87389 |
|
19 |
19 |
$200.45 |
| 86706 |
|
13 |
13 |
$185.57 |
| J3475 |
Inj magnesium sulfate |
20 |
16 |
$111.42 |
| 84100 |
|
16 |
13 |
$89.04 |
| 86431 |
|
13 |
12 |
$72.80 |
| 82950 |
|
12 |
12 |
$68.70 |
| 87205 |
|
13 |
12 |
$62.41 |
| 96376 |
|
107 |
78 |
$35.71 |
| 80050 |
|
126 |
126 |
$0.00 |