| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 80053 |
|
1,336 |
967 |
$128K |
| 99284 |
|
1,074 |
842 |
$82K |
| J3490 |
Unclassified drugs |
1,147 |
632 |
$80K |
| 0450 |
|
560 |
504 |
$48K |
| 76815 |
|
507 |
284 |
$43K |
| 77067 |
|
124 |
101 |
$33K |
| 99231 |
|
548 |
360 |
$28K |
| 70450 |
|
86 |
70 |
$25K |
| 96374 |
|
283 |
247 |
$24K |
| 74177 |
|
62 |
57 |
$23K |
| 59025 |
|
387 |
141 |
$19K |
| 93306 |
|
45 |
41 |
$18K |
| 77334 |
|
53 |
39 |
$17K |
| 93005 |
|
379 |
322 |
$17K |
| 96365 |
|
182 |
122 |
$16K |
| 80307 |
|
153 |
136 |
$15K |
| 77412 |
|
157 |
14 |
$15K |
| 76805 |
|
111 |
99 |
$14K |
| 96375 |
|
319 |
218 |
$13K |
| 85025 |
|
1,450 |
1,030 |
$13K |
| T1999 |
Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks" |
370 |
218 |
$13K |
| 0510 |
|
231 |
156 |
$13K |
| 96361 |
|
330 |
254 |
$13K |
| 76700 |
|
102 |
95 |
$12K |
| 96360 |
|
121 |
102 |
$11K |
| 76856 |
|
106 |
99 |
$10K |
| 99283 |
|
97 |
70 |
$9K |
| 87502 |
|
75 |
68 |
$9K |
| 71046 |
|
250 |
247 |
$9K |
| 76801 |
|
98 |
74 |
$9K |
| 76830 |
|
93 |
88 |
$8K |
| 77336 |
|
109 |
44 |
$7K |
| 77300 |
|
16 |
14 |
$7K |
| 93971 |
|
33 |
32 |
$7K |
| J0131 |
Injection, acetaminophen, not otherwise specified,10 mg |
80 |
38 |
$6K |
| 76817 |
|
78 |
62 |
$6K |
| 76816 |
|
80 |
72 |
$6K |
| 90791 |
|
35 |
34 |
$6K |
| 86803 |
|
255 |
235 |
$5K |
| 87491 |
|
83 |
71 |
$5K |
| 87591 |
|
83 |
71 |
$5K |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
213 |
167 |
$5K |
| 86703 |
|
236 |
217 |
$4K |
| 84484 |
|
231 |
183 |
$4K |
| 96413 |
|
96 |
45 |
$4K |
| 71045 |
|
181 |
179 |
$3K |
| 87086 |
|
290 |
263 |
$3K |
| 96372 |
|
178 |
117 |
$3K |
| 96366 |
|
74 |
38 |
$3K |
| J7030 |
Infusion, normal saline solution , 1000 cc |
224 |
185 |
$3K |
| 96367 |
|
62 |
32 |
$3K |
| 83690 |
|
263 |
226 |
$3K |
| Z7500 |
|
75 |
62 |
$3K |
| 80048 |
|
52 |
44 |
$2K |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
205 |
181 |
$2K |
| 92507 |
|
35 |
13 |
$2K |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
89 |
52 |
$2K |
| 83605 |
|
135 |
77 |
$2K |
| 84702 |
|
144 |
119 |
$2K |
| 81001 |
|
416 |
369 |
$2K |
| 94060 |
|
20 |
17 |
$2K |
| 0250 |
|
20 |
14 |
$2K |
| 94640 |
|
60 |
57 |
$2K |
| 71020 |
|
44 |
41 |
$2K |
| 83735 |
|
212 |
132 |
$2K |
| 82731 |
|
28 |
27 |
$2K |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
146 |
76 |
$2K |
| J2704 |
Injection, propofol, 10 mg |
57 |
44 |
$2K |
| 72100 |
|
39 |
36 |
$2K |
| 87040 |
|
112 |
63 |
$1K |
| 94729 |
|
16 |
13 |
$1K |
| 94726 |
|
17 |
14 |
$1K |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
60 |
50 |
$1K |
| J2270 |
Injection, morphine sulfate, up to 10 mg |
95 |
80 |
$1K |
| 96415 |
|
26 |
12 |
$952.45 |
| 84703 |
|
100 |
91 |
$919.76 |
| 87400 |
|
107 |
96 |
$902.30 |
| 86900 |
|
153 |
96 |
$821.13 |
| 99281 |
|
27 |
27 |
$814.46 |
| 80047 |
|
44 |
43 |
$785.93 |
| 84443 |
|
30 |
27 |
$762.18 |
| 83880 |
|
17 |
16 |
$735.73 |
| J7050 |
Infusion, normal saline solution, 250 cc |
31 |
15 |
$713.96 |
| 81025 |
|
127 |
116 |
$710.26 |
| 73030 |
|
15 |
14 |
$701.39 |
| 72040 |
|
17 |
16 |
$697.92 |
| 73630 |
|
18 |
17 |
$674.61 |
| 81003 |
|
152 |
134 |
$670.83 |
| 90715 |
|
14 |
13 |
$652.09 |
| 86850 |
|
81 |
66 |
$651.49 |
| J1200 |
Injection, diphenhydramine hcl, up to 50 mg |
95 |
60 |
$568.34 |
| 86901 |
|
122 |
96 |
$545.49 |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
51 |
43 |
$540.86 |
| 85610 |
|
103 |
94 |
$533.72 |
| J2001 |
Injection, lidocaine hcl for intravenous infusion, 10 mg |
103 |
63 |
$533.36 |
| 87081 |
|
50 |
46 |
$524.80 |
| Z7502 |
|
13 |
13 |
$520.80 |
| 82947 |
|
66 |
58 |
$483.07 |
| 73562 |
|
12 |
12 |
$478.10 |
| 85730 |
|
58 |
53 |
$466.38 |
| 85379 |
|
28 |
27 |
$448.00 |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
61 |
45 |
$408.28 |
| 87210 |
|
63 |
56 |
$396.83 |
| 83615 |
|
46 |
38 |
$394.50 |
| J2930 |
Injection, methylprednisolone sodium succinate, up to 125 mg |
19 |
13 |
$359.00 |
| J1170 |
Injection, hydromorphone, up to 4 mg |
33 |
18 |
$348.66 |
| 87077 |
|
42 |
40 |
$333.20 |
| 71010 |
|
22 |
21 |
$285.16 |
| 87186 |
|
38 |
36 |
$282.41 |
| J2765 |
Injection, metoclopramide hcl, up to 10 mg |
30 |
27 |
$251.96 |
| J2060 |
Injection, lorazepam, 2 mg |
30 |
20 |
$229.23 |
| 0710 |
|
15 |
12 |
$188.16 |
| 82570 |
|
21 |
17 |
$165.42 |
| 87147 |
|
24 |
12 |
$160.23 |
| 85027 |
|
15 |
15 |
$153.76 |
| 85014 |
|
50 |
49 |
$151.99 |
| 84550 |
|
20 |
18 |
$144.90 |
| 84100 |
|
25 |
16 |
$132.14 |
| J7620 |
Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme |
88 |
77 |
$130.20 |
| 82565 |
|
14 |
13 |
$125.30 |
| J0690 |
Injection, cefazolin sodium, 500 mg |
14 |
14 |
$124.25 |
| 84156 |
|
22 |
17 |
$122.37 |
| J2550 |
Injection, promethazine hcl, up to 50 mg |
13 |
13 |
$120.24 |
| 84450 |
|
14 |
13 |
$109.87 |
| 84460 |
|
13 |
12 |
$102.31 |
| 36415 |
|
71 |
46 |
$0.00 |
| G0463 |
Hospital outpatient clinic visit for assessment and management of a patient |
271 |
185 |
$0.00 |