| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 0450 |
|
8,019 |
7,047 |
$3K |
| 74176 |
|
1,091 |
1,044 |
$1K |
| 96374 |
|
2,323 |
2,108 |
$620.55 |
| 76811 |
|
175 |
173 |
$545.44 |
| 70450 |
|
1,142 |
1,090 |
$529.89 |
| 93976 |
|
342 |
331 |
$416.50 |
| 87635 |
|
1,944 |
1,795 |
$369.42 |
| 93005 |
|
3,129 |
2,799 |
$356.97 |
| 96375 |
|
2,047 |
1,561 |
$315.55 |
| 76817 |
|
450 |
407 |
$310.62 |
| 80053 |
|
3,978 |
3,420 |
$227.81 |
| 80307 |
|
1,330 |
1,139 |
$221.62 |
| 85025 |
|
5,789 |
4,714 |
$214.38 |
| 71045 |
|
2,435 |
2,286 |
$206.37 |
| 0760 |
|
562 |
456 |
$184.14 |
| 83880 |
|
1,125 |
1,038 |
$158.96 |
| 76830 |
|
562 |
538 |
$99.16 |
| 83690 |
|
2,093 |
1,860 |
$89.12 |
| 84484 |
|
2,075 |
1,710 |
$87.82 |
| 84443 |
|
831 |
758 |
$85.35 |
| U0003 |
Cov-19 amp prb hgh thruput |
351 |
345 |
$75.00 |
| 96361 |
|
1,229 |
1,006 |
$74.29 |
| 96360 |
|
216 |
214 |
$63.07 |
| 80048 |
|
1,880 |
1,585 |
$57.05 |
| 76705 |
|
304 |
290 |
$51.76 |
| 81001 |
|
2,410 |
2,219 |
$45.34 |
| 76815 |
|
1,011 |
587 |
$39.66 |
| J1170 |
Hydromorphone injection |
674 |
539 |
$38.89 |
| U0005 |
Infec agen detec ampli probe |
275 |
270 |
$25.00 |
| 84145 |
|
517 |
427 |
$24.88 |
| 81025 |
|
485 |
472 |
$22.98 |
| 84703 |
|
1,090 |
1,033 |
$21.72 |
| 87086 |
|
756 |
717 |
$16.02 |
| 82947 |
|
486 |
256 |
$7.78 |
| 81003 |
|
982 |
914 |
$7.72 |
| J2270 |
Morphine sulfate injection |
146 |
136 |
$7.18 |
| J1885 |
Ketorolac tromethamine inj |
641 |
602 |
$5.21 |
| J2001 |
Lidocaine injection |
368 |
342 |
$5.14 |
| 86850 |
|
338 |
316 |
$4.84 |
| J2405 |
Ondansetron hcl injection |
1,122 |
999 |
$4.77 |
| 85610 |
|
825 |
746 |
$2.13 |
| 86901 |
|
606 |
563 |
$2.11 |
| 86900 |
|
606 |
563 |
$1.48 |
| 83735 |
|
929 |
702 |
$0.00 |
| 83605 |
|
538 |
457 |
$0.00 |
| 85027 |
|
376 |
329 |
$0.00 |
| J1100 |
Dexamethasone sodium phos |
228 |
217 |
$0.00 |
| 80047 |
|
311 |
293 |
$0.00 |
| 86140 |
|
342 |
289 |
$0.00 |
| J2060 |
Lorazepam injection |
228 |
199 |
$0.00 |
| 0306 |
|
152 |
138 |
$0.00 |
| 0310 |
|
78 |
76 |
$0.00 |
| 76700 |
|
124 |
124 |
$0.00 |
| 97010 |
|
498 |
94 |
$0.00 |
| 0710 |
|
358 |
326 |
$0.00 |
| 0301 |
|
186 |
157 |
$0.00 |
| 76801 |
|
140 |
127 |
$0.00 |
| J7050 |
Normal saline solution infus |
130 |
125 |
$0.00 |
| 96372 |
|
938 |
676 |
$0.00 |
| 87205 |
|
29 |
27 |
$0.00 |
| 77063 |
|
789 |
787 |
$0.00 |
| J2704 |
Inj, propofol, 10 mg |
190 |
165 |
$0.00 |
| 96376 |
|
1,177 |
665 |
$0.00 |
| 82553 |
|
205 |
178 |
$0.00 |
| 87070 |
|
16 |
14 |
$0.00 |
| J2250 |
Inj midazolam hydrochloride |
177 |
168 |
$0.00 |
| 71275 |
|
217 |
211 |
$0.00 |
| 85652 |
|
105 |
91 |
$0.00 |
| J3490 |
Drugs unclassified injection |
971 |
637 |
$0.00 |
| 87040 |
|
546 |
337 |
$0.00 |
| 83036 |
|
24 |
18 |
$0.00 |
| 96365 |
|
407 |
335 |
$0.00 |
| 0171 |
Inj, epinephrine (belcher) |
72 |
72 |
$0.00 |
| 83615 |
|
19 |
19 |
$0.00 |
| 97140 |
|
269 |
94 |
$0.00 |
| 88305 |
|
111 |
97 |
$0.00 |
| 87077 |
|
26 |
26 |
$0.00 |
| 72148 |
|
145 |
138 |
$0.00 |
| 0258 |
|
336 |
237 |
$0.00 |
| A9585 |
Gadobutrol injection |
258 |
254 |
$0.00 |
| 0270 |
|
8,971 |
2,895 |
$0.00 |
| J3010 |
Fentanyl citrate injection |
314 |
246 |
$0.00 |
| 82550 |
|
362 |
313 |
$0.00 |
| 76641 |
|
452 |
359 |
$0.00 |
| 0250 |
|
451 |
297 |
$0.00 |
| 0636 |
|
241 |
171 |
$0.00 |
| J0696 |
Ceftriaxone sodium injection |
173 |
162 |
$0.00 |
| 0241U |
|
178 |
176 |
$0.00 |
| 93971 |
|
54 |
54 |
$0.00 |
| 87636 |
|
94 |
85 |
$0.00 |
| 0305 |
|
54 |
51 |
$0.00 |
| 82728 |
|
33 |
30 |
$0.00 |
| 85379 |
|
384 |
367 |
$0.00 |
| 87081 |
|
99 |
91 |
$0.00 |
| 0720 |
|
29 |
28 |
$0.00 |
| 85730 |
|
265 |
235 |
$0.00 |
| 96366 |
|
51 |
26 |
$0.00 |
| 97112 |
|
74 |
26 |
$0.00 |
| 87637 |
|
15 |
15 |
$0.00 |
| 73221 |
|
31 |
28 |
$0.00 |
| 83520 |
|
12 |
12 |
$0.00 |
| 0324 |
|
15 |
14 |
$0.00 |
| J0690 |
Cefazolin sodium injection |
16 |
13 |
$0.00 |
| 0307 |
|
13 |
12 |
$0.00 |
| 93306 |
|
28 |
25 |
$0.00 |
| 0272 |
|
457 |
301 |
$0.00 |
| J7120 |
Ringers lactate infusion |
69 |
59 |
$0.00 |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
960 |
915 |
$0.00 |
| 72125 |
|
314 |
294 |
$0.00 |
| 84702 |
|
803 |
740 |
$0.00 |
| J7030 |
Normal saline solution infus |
589 |
528 |
$0.00 |
| G1004 |
Cdsm ndsc |
2,789 |
2,016 |
$0.00 |
| 73630 |
|
69 |
65 |
$0.00 |
| 77080 |
|
171 |
171 |
$0.00 |
| 85014 |
|
197 |
172 |
$0.00 |
| 0360 |
|
145 |
120 |
$0.00 |
| 74177 |
|
320 |
308 |
$0.00 |
| 77066 |
Tomosynthesis, mammo |
218 |
218 |
$0.00 |
| 0160 |
|
864 |
504 |
$0.00 |
| 97530 |
|
253 |
106 |
$0.00 |
| 71046 |
|
343 |
331 |
$0.00 |
| 97110 |
|
1,182 |
267 |
$0.00 |
| 80076 |
|
227 |
198 |
$0.00 |
| 77062 |
|
87 |
87 |
$0.00 |
| 0122 |
|
90 |
85 |
$0.00 |
| 0300 |
|
185 |
166 |
$0.00 |
| 73030 |
|
45 |
43 |
$0.00 |
| 70553 |
|
29 |
29 |
$0.00 |
| 76856 |
|
594 |
572 |
$0.00 |
| 77061 |
|
27 |
27 |
$0.00 |
| 73721 |
|
31 |
27 |
$0.00 |
| 84100 |
|
73 |
40 |
$0.00 |
| 74018 |
|
41 |
37 |
$0.00 |
| 77065 |
Tomosynthesis, mammo |
148 |
142 |
$0.00 |
| 85007 |
|
33 |
32 |
$0.00 |
| 72141 |
|
86 |
79 |
$0.00 |
| 0302 |
|
81 |
77 |
$0.00 |
| 72100 |
|
91 |
91 |
$0.00 |
| 59025 |
|
351 |
137 |
$0.00 |
| J1200 |
Diphenhydramine hcl injectio |
60 |
55 |
$0.00 |
| 77067 |
|
787 |
786 |
$0.00 |
| 80061 |
|
16 |
12 |
$0.00 |
| G0279 |
Tomosynthesis, mammo |
218 |
217 |
$0.00 |
| 76642 |
|
52 |
45 |
$0.00 |
| 87880 |
|
12 |
12 |
$0.00 |
| 73610 |
|
14 |
13 |
$0.00 |
| 70551 |
|
29 |
28 |
$0.00 |
| 71250 |
|
19 |
19 |
$0.00 |
| 73562 |
|
99 |
89 |
$0.00 |
| 73130 |
|
13 |
13 |
$0.00 |
| 87631 |
|
14 |
13 |
$0.00 |
| 93970 |
|
13 |
13 |
$0.00 |
| 0730 |
|
15 |
14 |
$0.00 |