| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 0510 |
|
431,823 |
361,529 |
$12.57M |
| 0450 |
|
92,514 |
80,946 |
$5.59M |
| G0463 |
Hospital outpt clinic visit |
96,405 |
78,232 |
$3.73M |
| 87636 |
|
24,679 |
22,552 |
$3.56M |
| Z7502 |
|
55,257 |
54,606 |
$2.05M |
| J7307 |
Etonogestrel implant system |
1,204 |
1,195 |
$1.49M |
| 77067 |
|
17,547 |
17,435 |
$1.46M |
| 80307 |
|
11,210 |
10,189 |
$1.32M |
| 80053 |
|
144,572 |
137,423 |
$1.29M |
| 86480 |
|
24,401 |
24,165 |
$1.14M |
| 87491 |
|
49,314 |
48,120 |
$1.13M |
| 87591 |
|
49,322 |
48,128 |
$1.12M |
| 74177 |
|
5,619 |
5,476 |
$1.11M |
| 0360 |
|
9,464 |
5,947 |
$966K |
| 90750 |
|
6,964 |
6,950 |
$944K |
| 97139 |
|
45,481 |
17,251 |
$849K |
| 93306 |
|
5,436 |
5,361 |
$844K |
| 84443 |
|
69,739 |
68,990 |
$836K |
| 85025 |
|
112,806 |
106,160 |
$802K |
| 80061 |
|
87,996 |
87,527 |
$786K |
| 93005 |
|
31,967 |
30,338 |
$776K |
| 96110 |
|
11,069 |
11,012 |
$751K |
| 90677 |
|
4,442 |
4,428 |
$719K |
| 83036 |
|
102,846 |
102,175 |
$683K |
| 90686 |
|
35,688 |
35,629 |
$677K |
| 90715 |
|
17,109 |
17,045 |
$671K |
| 82306 |
|
33,508 |
33,357 |
$629K |
| 0225U |
|
1,945 |
1,917 |
$615K |
| 70450 |
|
4,306 |
4,158 |
$607K |
| 0750 |
|
4,693 |
4,664 |
$587K |
| 90471 |
|
100,688 |
99,329 |
$546K |
| 87389 |
|
27,091 |
26,854 |
$512K |
| 96374 |
|
7,547 |
7,160 |
$479K |
| 90651 |
|
7,539 |
7,507 |
$460K |
| 87633 |
|
1,121 |
1,104 |
$423K |
| 96365 |
|
5,090 |
3,833 |
$376K |
| 90739 |
|
1,754 |
1,753 |
$341K |
| 97750 |
|
7,933 |
7,426 |
$335K |
| J3490 |
Drugs unclassified injection |
31,101 |
16,148 |
$329K |
| 99284 |
|
5,973 |
5,300 |
$317K |
| 73721 |
|
1,660 |
1,616 |
$316K |
| Z7610 |
|
38,570 |
24,208 |
$311K |
| 76641 |
|
3,740 |
3,227 |
$299K |
| 87624 |
|
9,762 |
9,742 |
$299K |
| 71046 |
|
15,535 |
15,051 |
$296K |
| 96372 |
|
13,398 |
11,989 |
$282K |
| 90746 |
|
4,652 |
4,628 |
$268K |
| 90679 |
|
797 |
791 |
$265K |
| 77066 |
Tomosynthesis, mammo |
2,345 |
2,323 |
$260K |
| 97799 |
|
13,398 |
4,536 |
$259K |
| 77065 |
Tomosynthesis, mammo |
3,025 |
2,949 |
$258K |
| 0900 |
|
8,993 |
5,241 |
$257K |
| J7298 |
Mirena, 52 mg |
215 |
215 |
$255K |
| 82274 |
|
22,400 |
22,322 |
$247K |
| 90688 |
|
12,670 |
12,625 |
$247K |
| 0710 |
|
10,727 |
10,584 |
$242K |
| 76705 |
|
4,820 |
4,802 |
$238K |
| 72148 |
|
1,452 |
1,436 |
$236K |
| 71260 |
|
1,664 |
1,642 |
$234K |
| 99070 |
|
95,727 |
45,848 |
$232K |
| 85027 |
|
45,085 |
43,223 |
$222K |
| 86803 |
|
18,817 |
18,707 |
$219K |
| 76856 |
|
3,798 |
3,766 |
$216K |
| 81025 |
|
35,566 |
33,621 |
$210K |
| 87536 |
|
3,638 |
3,560 |
$204K |
| G9920 |
Scrning perf and negative |
5,801 |
5,794 |
$200K |
| 86780 |
|
18,880 |
18,646 |
$199K |
| 80074 |
|
5,392 |
5,364 |
$197K |
| 76830 |
|
3,449 |
3,419 |
$197K |
| 96360 |
|
3,177 |
3,007 |
$195K |
| 74176 |
|
1,920 |
1,897 |
$189K |
| 90682 |
|
6,497 |
6,485 |
$186K |
| 80048 |
|
29,250 |
27,526 |
$181K |
| 90716 |
|
4,432 |
4,399 |
$178K |
| 96375 |
|
5,109 |
4,630 |
$175K |
| 87631 |
|
2,885 |
2,812 |
$172K |
| 76811 |
|
1,772 |
1,685 |
$171K |
| 90670 |
|
2,961 |
2,937 |
$167K |
| 96413 |
|
5,228 |
3,163 |
$161K |
| 96156 |
|
1,759 |
1,692 |
$156K |
| 76700 |
|
2,699 |
2,629 |
$156K |
| 87635 |
|
2,764 |
2,698 |
$156K |
| U0004 |
Cov-19 test non-cdc hgh thru |
2,428 |
2,384 |
$153K |
| 83690 |
|
16,835 |
16,051 |
$152K |
| 73221 |
|
905 |
883 |
$151K |
| 81003 |
|
67,537 |
59,793 |
$150K |
| 99283 |
|
4,365 |
3,865 |
$145K |
| 84484 |
|
10,962 |
10,103 |
$145K |
| 96158 |
|
2,480 |
1,826 |
$143K |
| 71250 |
|
1,319 |
1,311 |
$124K |
| 92014 |
|
5,527 |
5,240 |
$124K |
| 20610 |
|
5,353 |
5,182 |
$123K |
| 92552 |
|
6,520 |
6,463 |
$123K |
| 88175 |
|
13,543 |
13,506 |
$117K |
| 76770 |
|
2,089 |
2,057 |
$115K |
| 96361 |
|
5,306 |
4,879 |
$113K |
| 0241U |
|
699 |
691 |
$113K |
| 97165 |
|
2,977 |
2,141 |
$111K |
| 0352U |
|
972 |
953 |
$108K |
| 86003 |
|
1,776 |
1,757 |
$108K |
| J1885 |
Ketorolac tromethamine inj |
17,112 |
15,744 |
$105K |
| 90707 |
|
2,780 |
2,760 |
$103K |
| 0012A |
|
3,445 |
3,445 |
$102K |
| 96112 |
|
2,558 |
2,552 |
$99K |
| 86706 |
|
11,089 |
11,028 |
$98K |
| 73630 |
|
4,365 |
4,086 |
$97K |
| 87880 |
|
8,253 |
8,116 |
$96K |
| 82043 |
|
26,689 |
26,511 |
$96K |
| 82570 |
|
29,212 |
28,822 |
$96K |
| 87340 |
|
11,094 |
10,925 |
$94K |
| 82948 |
|
38,301 |
29,566 |
$94K |
| 84439 |
|
14,651 |
14,419 |
$92K |
| J1050 |
Medroxyprogesterone acetate |
3,912 |
3,891 |
$92K |
| 76536 |
|
1,905 |
1,877 |
$89K |
| 93017 |
|
1,545 |
1,526 |
$89K |
| 94640 |
|
6,261 |
3,370 |
$85K |
| J0897 |
Denosumab injection |
70 |
62 |
$84K |
| 93226 |
|
1,556 |
1,556 |
$82K |
| 70551 |
|
455 |
454 |
$82K |
| 83880 |
|
3,856 |
3,689 |
$82K |
| 96415 |
|
2,387 |
1,822 |
$82K |
| 93971 |
|
916 |
883 |
$80K |
| 99281 |
|
2,607 |
2,211 |
$79K |
| 83970 |
|
3,409 |
3,366 |
$79K |
| 84153 |
|
6,533 |
6,439 |
$79K |
| 86360 |
|
2,587 |
2,574 |
$78K |
| 73610 |
|
3,238 |
3,096 |
$78K |
| 90649 |
|
837 |
828 |
$77K |
| 87653 |
|
2,590 |
2,565 |
$75K |
| 0002A |
|
2,477 |
2,477 |
$74K |
| 83550 |
|
13,966 |
13,816 |
$74K |
| 87557 |
|
1,674 |
1,665 |
$73K |
| J3010 |
Fentanyl citrate injection |
11,737 |
11,521 |
$73K |
| 93351 |
|
657 |
634 |
$73K |
| 82728 |
|
8,898 |
8,798 |
$73K |
| 92557 |
|
1,272 |
1,235 |
$72K |
| 99282 |
|
3,320 |
2,880 |
$72K |
| 73110 |
|
2,902 |
2,718 |
$71K |
| 11721 |
|
7,918 |
7,780 |
$71K |
| 71045 |
|
6,844 |
6,585 |
$70K |
| 84403 |
|
3,332 |
3,284 |
$68K |
| 90678 |
|
194 |
193 |
$68K |
| 94060 |
|
2,017 |
1,981 |
$66K |
| 90633 |
|
5,715 |
5,681 |
$65K |
| 45378 |
|
2,229 |
2,188 |
$65K |
| 81220 |
|
619 |
613 |
$65K |
| 73030 |
|
2,971 |
2,834 |
$65K |
| 83540 |
|
14,848 |
14,678 |
$64K |
| 73564 |
|
3,799 |
3,726 |
$64K |
| 87088 |
|
11,613 |
10,998 |
$62K |
| 87086 |
|
9,291 |
8,842 |
$62K |
| 73130 |
|
2,486 |
2,344 |
$61K |
| J7300 |
Intra copp contra (paragard) |
50 |
50 |
$60K |
| 87581 |
|
1,184 |
1,165 |
$59K |
| 92012 |
|
2,766 |
2,599 |
$59K |
| 87486 |
|
1,183 |
1,164 |
$59K |
| 72100 |
|
2,494 |
2,472 |
$58K |
| 0001A |
|
2,863 |
2,861 |
$58K |
| 87798 |
|
1,216 |
1,195 |
$58K |
| 45385 |
|
1,543 |
1,510 |
$58K |
| 0011A |
|
3,353 |
3,353 |
$58K |
| 76805 |
|
731 |
731 |
$57K |
| 86762 |
|
4,539 |
4,508 |
$56K |
| 70553 |
|
183 |
179 |
$56K |
| 93225 |
|
1,860 |
1,819 |
$55K |
| 94726 |
|
1,478 |
1,476 |
$55K |
| 0072A |
|
1,325 |
1,325 |
$53K |
| 80076 |
|
9,651 |
9,500 |
$53K |
| 90662 |
|
1,868 |
1,861 |
$53K |
| J2405 |
Ondansetron hcl injection |
9,743 |
9,146 |
$52K |
| 86787 |
|
4,712 |
4,645 |
$52K |
| 87502 |
|
766 |
762 |
$51K |
| 70486 |
|
351 |
350 |
$51K |
| 52000 |
|
1,056 |
1,026 |
$51K |
| 0071A |
|
1,269 |
1,269 |
$50K |
| 92083 |
|
4,540 |
4,354 |
$50K |
| 86235 |
|
616 |
611 |
$49K |
| J2250 |
Inj midazolam hydrochloride |
9,866 |
9,739 |
$49K |
| 87040 |
|
2,406 |
2,286 |
$48K |
| 90736 |
|
201 |
201 |
$48K |
| 76642 |
|
826 |
824 |
$48K |
| 99285 |
|
626 |
589 |
$47K |
| 97110 |
|
9,118 |
5,404 |
$47K |
| 86704 |
|
4,655 |
4,616 |
$46K |
| 83655 |
|
5,211 |
5,155 |
$46K |
| 73560 |
|
2,649 |
2,600 |
$46K |
| 83735 |
|
7,089 |
6,506 |
$45K |
| 87661 |
|
1,290 |
1,269 |
$45K |
| 72125 |
|
213 |
211 |
$44K |
| 81001 |
|
12,457 |
12,048 |
$44K |
| 87804 |
|
3,923 |
3,868 |
$43K |
| 90744 |
|
3,787 |
3,776 |
$43K |
| 85610 |
|
15,270 |
11,795 |
$43K |
| 92004 |
|
1,988 |
1,906 |
$42K |
| 90714 |
|
1,700 |
1,700 |
$41K |
| 96127 |
|
7,612 |
7,590 |
$41K |
| 82105 |
|
3,130 |
3,094 |
$41K |
| 0004A |
|
1,132 |
1,132 |
$39K |
| 86140 |
|
9,326 |
8,990 |
$39K |
| 76857 |
|
2,431 |
2,371 |
$39K |
| 94729 |
|
1,536 |
1,534 |
$38K |
| 87517 |
|
1,358 |
1,345 |
$38K |
| 96366 |
|
1,004 |
861 |
$37K |
| 82746 |
|
4,269 |
4,242 |
$37K |
| 90698 |
|
3,226 |
3,215 |
$37K |
| 11056 |
|
2,440 |
2,406 |
$37K |
| 87522 |
Neg quan hep c or qual rna |
1,243 |
1,209 |
$36K |
| 87506 |
|
168 |
166 |
$34K |
| 72141 |
|
190 |
189 |
$34K |
| J2704 |
Inj, propofol, 10 mg |
3,991 |
3,932 |
$33K |
| 83605 |
|
2,300 |
2,175 |
$33K |
| 92595 |
|
622 |
616 |
$33K |
| 92133 |
|
2,881 |
2,778 |
$32K |
| 0762 |
|
182 |
177 |
$32K |
| J0690 |
Cefazolin sodium injection |
3,721 |
3,620 |
$31K |
| 92507 |
|
650 |
386 |
$29K |
| 87081 |
|
5,076 |
5,031 |
$29K |
| 76870 |
|
585 |
579 |
$29K |
| 92567 |
|
913 |
912 |
$29K |
| 87186 |
|
3,991 |
3,854 |
$28K |
| 73523 |
|
749 |
736 |
$28K |
| 90734 |
|
2,452 |
2,446 |
$28K |
| 85007 |
|
10,422 |
9,444 |
$28K |
| J2765 |
Metoclopramide hcl injection |
4,367 |
4,295 |
$27K |
| 84481 |
|
2,289 |
2,263 |
$27K |
| J2270 |
Morphine sulfate injection |
3,106 |
2,689 |
$27K |
| 82785 |
|
1,675 |
1,658 |
$26K |
| 83001 |
|
1,675 |
1,662 |
$26K |
| 90713 |
|
1,824 |
1,809 |
$26K |
| J7050 |
Normal saline solution infus |
4,698 |
2,751 |
$25K |
| 85018 |
|
11,654 |
11,438 |
$25K |
| H1003 |
Prenatal at risk education |
1,238 |
1,178 |
$25K |
| 84146 |
|
1,567 |
1,547 |
$24K |
| J1100 |
Dexamethasone sodium phos |
4,156 |
3,984 |
$24K |
| 86038 |
|
3,405 |
3,349 |
$24K |
| 76801 |
|
406 |
382 |
$24K |
| 87070 |
|
2,880 |
2,790 |
$24K |
| 90710 |
|
1,982 |
1,977 |
$23K |
| 90480 |
|
1,495 |
1,495 |
$23K |
| S0020 |
Injection, bupivicaine hydro |
2,057 |
1,980 |
$23K |
| 85730 |
|
3,810 |
3,640 |
$22K |
| 93350 |
|
427 |
404 |
$22K |
| 84402 |
|
1,045 |
1,018 |
$22K |
| J0696 |
Ceftriaxone sodium injection |
2,935 |
2,370 |
$21K |
| 73080 |
|
846 |
812 |
$21K |
| 90696 |
|
1,857 |
1,852 |
$21K |
| 85379 |
|
1,604 |
1,592 |
$21K |
| J1170 |
Hydromorphone injection |
2,169 |
1,842 |
$21K |
| 71275 |
|
107 |
107 |
$20K |
| 74018 |
|
1,104 |
1,048 |
$20K |
| J1642 |
Inj heparin sodium per 10 u |
2,916 |
1,348 |
$20K |
| 96417 |
|
589 |
378 |
$20K |
| 87507 |
|
59 |
58 |
$20K |
| 90656 |
|
991 |
991 |
$20K |
| 86850 |
|
4,867 |
4,624 |
$19K |
| 87801 |
|
532 |
528 |
$19K |
| 86709 |
|
2,170 |
2,092 |
$19K |
| 83516 |
|
2,304 |
2,267 |
$19K |
| 84460 |
|
4,487 |
4,460 |
$19K |
| 73502 |
|
836 |
808 |
$19K |
| 87210 |
|
4,374 |
4,288 |
$19K |
| 82607 |
|
4,607 |
4,569 |
$19K |
| 31575 |
|
592 |
582 |
$19K |
| 74150 |
|
92 |
87 |
$18K |
| 82565 |
|
5,227 |
5,114 |
$18K |
| 86901 |
|
5,454 |
5,146 |
$18K |
| 45380 |
|
623 |
595 |
$18K |
| 97161 |
|
662 |
575 |
$17K |
| 11055 |
|
1,278 |
1,263 |
$17K |
| 82670 |
|
961 |
952 |
$17K |
| 84702 |
|
1,131 |
847 |
$16K |
| 82947 |
|
5,358 |
5,313 |
$16K |
| 73620 |
|
706 |
692 |
$16K |
| 90619 |
|
1,345 |
1,342 |
$16K |
| 73140 |
|
958 |
935 |
$16K |
| 82378 |
|
1,174 |
1,074 |
$15K |
| 84450 |
|
3,605 |
3,588 |
$15K |
| 81002 |
|
7,131 |
5,328 |
$15K |
| 86318 |
|
771 |
764 |
$15K |
| 82550 |
|
2,523 |
2,380 |
$15K |
| 86765 |
|
1,291 |
1,281 |
$15K |
| 43235 |
|
532 |
532 |
$15K |
| 70498 |
|
81 |
81 |
$15K |
| 90685 |
|
1,326 |
1,322 |
$15K |
| 84550 |
|
4,765 |
4,702 |
$15K |
| 90792 |
|
544 |
455 |
$15K |
| 80069 |
|
2,973 |
2,839 |
$14K |
| 43239 |
|
510 |
495 |
$14K |
| 99401 |
|
845 |
761 |
$14K |
| 90732 |
|
445 |
441 |
$14K |
| 86255 |
|
1,203 |
1,173 |
$14K |
| 82950 |
|
3,422 |
3,416 |
$14K |
| 88720 |
|
2,712 |
1,793 |
$14K |
| A4267 |
Male condom |
1,373 |
1,354 |
$14K |
| 88342 |
|
960 |
947 |
$14K |
| 86900 |
|
5,035 |
4,783 |
$13K |
| 96111 |
|
453 |
443 |
$13K |
| 0064A |
|
437 |
437 |
$13K |
| 86735 |
|
1,116 |
1,109 |
$12K |
| 82977 |
|
2,205 |
2,191 |
$12K |
| 11981 |
|
677 |
675 |
$12K |
| 0124A |
|
1,415 |
1,413 |
$11K |
| 86705 |
|
1,186 |
1,180 |
$11K |
| 83002 |
|
734 |
728 |
$11K |
| 70543 |
|
39 |
38 |
$11K |
| U0002 |
Covid-19 lab test non-cdc |
217 |
199 |
$11K |
| 86593 |
|
2,974 |
2,881 |
$11K |
| J3301 |
Triamcinolone acet inj nos |
1,192 |
1,179 |
$10K |
| 90733 |
|
724 |
722 |
$10K |
| 87209 |
|
1,015 |
746 |
$10K |
| 90658 |
|
361 |
361 |
$10K |
| 90681 |
|
822 |
813 |
$10K |
| 90853 |
|
1,185 |
466 |
$10K |
| 73562 |
|
487 |
460 |
$10K |
| 82784 |
|
1,655 |
1,634 |
$10K |
| 76817 |
|
151 |
141 |
$9K |
| 83883 |
|
1,021 |
909 |
$9K |
| 86225 |
|
1,021 |
1,004 |
$9K |
| 36415 |
|
46,903 |
41,935 |
$9K |
| J0330 |
Succinycholine chloride inj |
367 |
364 |
$9K |
| 92134 |
|
773 |
769 |
$9K |
| 20550 |
|
1,016 |
971 |
$9K |
| 69209 |
|
1,117 |
1,085 |
$9K |
| 11720 |
|
1,552 |
1,536 |
$8K |
| 92015 |
|
1,243 |
1,109 |
$8K |
| 86039 |
|
1,078 |
1,060 |
$8K |
| 84165 |
|
1,266 |
1,235 |
$8K |
| J1200 |
Diphenhydramine hcl injectio |
1,297 |
1,203 |
$8K |
| 74170 |
|
38 |
38 |
$8K |
| 86376 |
|
627 |
622 |
$8K |
| 87529 |
|
268 |
265 |
$8K |
| 86430 |
|
1,650 |
1,637 |
$7K |
| 11982 |
|
413 |
409 |
$7K |
| 83525 |
|
740 |
738 |
$7K |
| J2060 |
Lorazepam injection |
1,278 |
1,155 |
$7K |
| 82627 |
|
393 |
388 |
$7K |
| 58300 |
|
972 |
966 |
$7K |
| 51798 |
|
594 |
592 |
$7K |
| 11750 |
|
277 |
272 |
$7K |
| 96132 |
|
130 |
121 |
$7K |
| J0171 |
Adrenalin epinephrine inject |
906 |
893 |
$7K |
| 87045 |
|
865 |
848 |
$7K |
| 82951 |
|
609 |
606 |
$7K |
| 87149 |
|
668 |
296 |
$7K |
| 84100 |
|
2,186 |
2,042 |
$7K |
| 87177 |
|
1,019 |
749 |
$6K |
| 85651 |
|
2,514 |
2,300 |
$6K |
| J1644 |
Inj heparin sodium per 1000u |
2,688 |
1,550 |
$6K |
| 87799 |
|
210 |
208 |
$6K |
| 72052 |
|
164 |
163 |
$6K |
| 85652 |
|
2,776 |
2,711 |
$6K |
| J2001 |
Lidocaine injection |
1,180 |
1,152 |
$6K |
| 84156 |
|
2,473 |
2,364 |
$6K |
| 82248 |
|
1,559 |
1,456 |
$6K |
| J2710 |
Neostigmine methylslfte inj |
335 |
332 |
$6K |
| 83498 |
|
242 |
240 |
$6K |
| 97530 |
|
834 |
516 |
$6K |
| 83721 |
|
788 |
776 |
$5K |
| 69210 |
|
809 |
799 |
$5K |
| 70496 |
|
29 |
29 |
$5K |
| 72020 |
|
479 |
479 |
$5K |
| 82330 |
|
656 |
638 |
$5K |
| 97140 |
|
1,401 |
1,079 |
$5K |
| 20553 |
|
388 |
383 |
$5K |
| 11765 |
|
238 |
216 |
$5K |
| G2066 |
Inter devc remote 30d |
260 |
258 |
$5K |
| J2272 |
Inj, morphine (fresenius) |
347 |
324 |
$5K |
| 71020 |
|
201 |
116 |
$5K |
| 91320 |
|
1,057 |
1,057 |
$5K |
| J1756 |
Iron sucrose injection |
95 |
39 |
$5K |
| 87651 |
|
140 |
138 |
$5K |
| 83010 |
|
527 |
522 |
$5K |
| 83615 |
|
1,071 |
1,018 |
$5K |
| J2930 |
Methylprednisolone injection |
359 |
301 |
$4K |
| 72072 |
|
158 |
158 |
$4K |
| 85045 |
|
1,503 |
1,491 |
$4K |
| 90700 |
|
378 |
376 |
$4K |
| 87116 |
|
709 |
313 |
$4K |
| 58100 |
|
141 |
140 |
$4K |
| 98967 |
|
706 |
639 |
$4K |
| 64483 |
|
88 |
88 |
$4K |
| 82310 |
|
1,201 |
1,163 |
$4K |
| 97150 |
|
629 |
279 |
$4K |
| V5010 |
Assessment for hearing aid |
59 |
59 |
$4K |
| 97003 |
|
99 |
75 |
$4K |
| 83993 |
|
234 |
227 |
$4K |
| 84445 |
|
94 |
93 |
$4K |
| 82172 |
|
335 |
333 |
$4K |
| 47562 |
|
12 |
12 |
$4K |
| J0665 |
Inj, bupivacaine, nos, 0.5mg |
671 |
643 |
$4K |
| 82533 |
|
299 |
292 |
$4K |
| 90834 |
|
231 |
177 |
$3K |
| 90632 |
|
55 |
55 |
$3K |
| 86200 |
|
535 |
525 |
$3K |
| 11100 |
|
223 |
195 |
$3K |
| 71101 |
|
83 |
82 |
$3K |
| 10060 |
|
162 |
154 |
$3K |
| 85014 |
|
1,600 |
1,571 |
$3K |
| 97162 |
|
163 |
161 |
$3K |
| 87077 |
|
723 |
710 |
$3K |
| 87338 |
|
769 |
769 |
$3K |
| 0112A |
|
69 |
69 |
$3K |
| 17110 |
|
535 |
491 |
$3K |
| 58301 |
|
430 |
428 |
$3K |
| 70491 |
|
14 |
14 |
$3K |
| 82009 |
|
499 |
473 |
$3K |
| 95909 |
|
52 |
50 |
$3K |
| 87641 |
|
96 |
94 |
$3K |
| G9919 |
Scrn nd pos nd prov of rec |
75 |
75 |
$3K |
| 96116 |
|
94 |
79 |
$3K |
| 95886 |
|
51 |
51 |
$3K |
| 0513 |
Prolong prev svcs, addl 30m |
95 |
94 |
$3K |
| 66984 |
|
12 |
12 |
$2K |
| 70320 |
|
83 |
83 |
$2K |
| 87015 |
|
480 |
211 |
$2K |
| 86364 |
|
179 |
179 |
$2K |
| J3475 |
Inj magnesium sulfate |
310 |
262 |
$2K |
| 74178 |
|
12 |
12 |
$2K |
| 73590 |
|
122 |
120 |
$2K |
| 94375 |
|
134 |
133 |
$2K |
| 99199 |
|
47 |
38 |
$2K |
| 0003A |
|
56 |
56 |
$2K |
| G0202 |
Scr mammo bi incl cad |
23 |
23 |
$2K |
| 73503 |
|
54 |
54 |
$2K |
| 92132 |
|
169 |
168 |
$2K |
| 87520 |
|
112 |
110 |
$2K |
| 0918 |
|
66 |
62 |
$2K |
| 97535 |
|
1,042 |
857 |
$2K |
| 86015 |
|
153 |
152 |
$2K |
| 87206 |
|
441 |
192 |
$2K |
| 84132 |
|
765 |
720 |
$2K |
| 73660 |
|
131 |
126 |
$2K |
| J1596 |
Inj, glycopyrrolate, 0.1 mg |
281 |
280 |
$2K |
| 11900 |
|
297 |
293 |
$2K |
| 90674 |
|
160 |
160 |
$2K |
| 82150 |
|
346 |
338 |
$2K |
| 86334 |
|
119 |
119 |
$2K |
| 94644 |
|
75 |
73 |
$2K |
| 93296 |
|
61 |
61 |
$2K |
| 92002 |
|
90 |
88 |
$2K |
| 82390 |
|
181 |
179 |
$2K |
| 0915 |
|
54 |
33 |
$2K |
| 87807 |
|
187 |
185 |
$2K |
| 86381 |
|
132 |
131 |
$1K |
| 31231 |
|
123 |
121 |
$1K |
| 82952 |
|
428 |
425 |
$1K |
| G8510 |
Scr dep neg, no plan reqd |
320 |
319 |
$1K |
| 74019 |
|
67 |
65 |
$1K |
| 0013A |
|
35 |
35 |
$1K |
| 84425 |
|
95 |
94 |
$1K |
| 82803 |
|
52 |
52 |
$1K |
| 00142 |
|
12 |
12 |
$1K |
| 29125 |
|
193 |
191 |
$1K |
| J1815 |
Insulin injection |
161 |
137 |
$1K |
| 86160 |
|
81 |
80 |
$1K |
| 0054A |
|
429 |
429 |
$1K |
| 90648 |
|
111 |
111 |
$1K |
| 99392 |
|
24 |
24 |
$1K |
| 0074A |
|
27 |
27 |
$1K |
| G0008 |
Admin influenza virus vac |
6,457 |
6,404 |
$1K |
| 83986 |
|
347 |
347 |
$1K |
| T1999 |
Noc retail items andsupplies |
203 |
122 |
$1K |
| 87328 |
|
124 |
123 |
$1K |
| 83021 |
|
95 |
93 |
$1K |
| 92250 |
|
148 |
145 |
$1K |
| 0154A |
|
25 |
25 |
$1K |
| 29580 |
|
112 |
39 |
$922.83 |
| 92136 |
|
29 |
26 |
$911.64 |
| J3420 |
Vitamin b12 injection |
376 |
268 |
$909.60 |
| 84300 |
|
306 |
301 |
$906.20 |
| 87329 |
|
124 |
123 |
$879.12 |
| 90620 |
|
69 |
67 |
$875.34 |
| 86696 |
|
82 |
82 |
$861.16 |
| 11983 |
|
53 |
53 |
$861.00 |
| 82103 |
|
71 |
70 |
$748.54 |
| 86695 |
|
82 |
82 |
$748.16 |
| 86708 |
|
70 |
70 |
$737.12 |
| 98968 |
|
118 |
109 |
$736.44 |
| 80164 |
|
81 |
80 |
$735.63 |
| J2175 |
Meperidine hydrochl /100 mg |
60 |
59 |
$734.39 |
| 86308 |
|
124 |
123 |
$713.83 |
| 11730 |
|
66 |
64 |
$701.10 |
| 96150 |
|
61 |
51 |
$693.17 |
| 82340 |
|
148 |
147 |
$688.43 |
| 90381 |
|
61 |
61 |
$675.27 |
| 11042 |
|
30 |
24 |
$674.45 |
| 73090 |
|
40 |
38 |
$666.62 |
| 86580 |
|
157 |
154 |
$664.49 |
| 82507 |
|
29 |
29 |
$656.64 |
| 12001 |
|
40 |
39 |
$590.40 |
| J2920 |
Methylprednisolone injection |
66 |
57 |
$487.75 |
| 99213 |
|
20 |
20 |
$477.68 |
| J2919 |
Inj, methylpred sod succ 5mg |
79 |
68 |
$452.32 |
| 76942 |
|
16 |
16 |
$450.83 |
| 97803 |
|
32 |
27 |
$449.31 |
| J0780 |
Prochlorperazine injection |
27 |
24 |
$414.20 |
| 96523 |
|
15 |
13 |
$401.22 |
| S4993 |
Contraceptive pills for bc |
27 |
26 |
$390.89 |
| 72040 |
|
20 |
20 |
$388.96 |
| 98966 |
|
142 |
125 |
$384.03 |
| 51701 |
|
27 |
27 |
$383.77 |
| 87449 |
|
46 |
46 |
$374.66 |
| 87427 |
|
46 |
46 |
$342.86 |
| 77063 |
|
12 |
12 |
$329.64 |
| 20600 |
|
13 |
12 |
$325.22 |
| J3489 |
Zoledronic acid 1mg |
19 |
12 |
$309.27 |
| 83945 |
|
29 |
29 |
$307.26 |
| 11057 |
|
28 |
28 |
$284.43 |
| 84145 |
|
13 |
12 |
$284.18 |
| 87205 |
|
65 |
61 |
$283.01 |
| 17000 |
|
39 |
37 |
$275.19 |
| J7060 |
5% dextrose/water |
36 |
24 |
$274.84 |
| 86812 |
|
12 |
12 |
$270.84 |
| J7611 |
Albuterol non-comp con |
1,174 |
975 |
$266.45 |
| 99195 |
|
16 |
16 |
$264.95 |
| 85246 |
|
12 |
12 |
$240.72 |
| 86665 |
|
13 |
13 |
$240.50 |
| J1836 |
Inj, metronidazole, 10 mg |
29 |
13 |
$231.78 |
| 86682 |
|
24 |
24 |
$227.60 |
| 82247 |
|
71 |
69 |
$225.12 |
| 29515 |
|
30 |
29 |
$220.14 |
| 97116 |
|
66 |
48 |
$206.40 |
| 80051 |
|
38 |
36 |
$197.39 |
| 83921 |
|
25 |
25 |
$187.72 |
| 84133 |
|
56 |
56 |
$180.48 |
| 90673 |
|
37 |
37 |
$175.78 |
| 83695 |
|
16 |
16 |
$169.95 |
| 93280 |
|
15 |
12 |
$149.85 |
| 82465 |
|
43 |
42 |
$137.88 |
| 46600 |
|
12 |
12 |
$135.30 |
| 84703 |
|
12 |
12 |
$132.10 |
| 76882 |
|
12 |
12 |
$129.58 |
| 84166 |
|
12 |
12 |
$124.80 |
| 94664 |
|
32 |
32 |
$123.10 |
| 84105 |
|
29 |
29 |
$122.85 |
| 86664 |
|
13 |
13 |
$120.25 |
| 87147 |
|
32 |
32 |
$119.35 |
| 84392 |
|
29 |
29 |
$116.64 |
| G0145 |
Scr c/v cyto,thinlayer,rescr |
142 |
133 |
$114.54 |
| 84560 |
|
29 |
29 |
$112.32 |
| 84520 |
|
37 |
37 |
$111.60 |
| J7613 |
Albuterol non-comp unit |
1,727 |
1,654 |
$108.48 |
| G0009 |
Admin pneumococcal vaccine |
1,314 |
1,292 |
$105.70 |
| 89055 |
|
27 |
27 |
$98.91 |
| 97810 |
|
12 |
12 |
$85.44 |
| 97124 |
|
27 |
12 |
$70.90 |
| 76514 |
|
13 |
13 |
$58.24 |
| G0472 |
Hep c screen high risk/other |
24 |
24 |
$57.01 |
| J1630 |
Haloperidol injection |
15 |
12 |
$54.55 |
| J7030 |
Normal saline solution infus |
405 |
311 |
$47.76 |
| 0270 |
|
23 |
13 |
$46.99 |
| 80178 |
|
13 |
13 |
$37.40 |
| 91319 |
|
38 |
38 |
$27.00 |
| 83935 |
|
14 |
13 |
$26.80 |
| 81050 |
|
13 |
13 |
$20.76 |
| 84155 |
|
12 |
12 |
$17.52 |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
99 |
99 |
$12.00 |
| A6446 |
Conform band s w>=3" <5"/yd |
26 |
26 |
$11.25 |
| 94761 |
|
47 |
47 |
$7.50 |
| J8499 |
Oral prescrip drug non chemo |
17 |
17 |
$5.97 |
| A9270 |
Non-covered item or service |
6,397 |
1,844 |
$4.54 |
| G8978 |
Mobility current status |
212 |
205 |
$0.16 |
| G0103 |
Psa screening |
58 |
58 |
$0.00 |
| G8980 |
Mobility d/c status |
79 |
79 |
$0.00 |
| 91305 |
|
363 |
363 |
$0.00 |
| 91306 |
|
112 |
112 |
$0.00 |
| 88142 |
|
34 |
34 |
$0.00 |
| G0010 |
Admin hepatitis b vaccine |
39 |
39 |
$0.00 |
| 91300 |
|
124 |
124 |
$0.00 |
| G8985 |
Carry goal status |
105 |
99 |
$0.00 |
| J1240 |
Dimenhydrinate injection |
13 |
12 |
$0.00 |
| G8984 |
Carry current status |
83 |
79 |
$0.00 |
| G8979 |
Mobility goal status |
257 |
247 |
$0.00 |
| 90472 |
|
28 |
28 |
$0.00 |