| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 70553 |
|
2,792 |
2,288 |
$664K |
| 85025 |
|
53,559 |
32,492 |
$432K |
| P9040 |
Rbc leukoreduced irradiated |
1,316 |
913 |
$428K |
| 80053 |
|
37,302 |
22,986 |
$421K |
| 36430 |
|
1,609 |
966 |
$285K |
| 93306 |
|
824 |
670 |
$189K |
| 96409 |
|
1,635 |
704 |
$179K |
| 86900 |
|
4,916 |
3,152 |
$176K |
| 83021 |
|
8,305 |
6,997 |
$172K |
| 83735 |
|
24,394 |
11,129 |
$129K |
| 96413 |
|
759 |
273 |
$123K |
| 83615 |
|
20,923 |
13,909 |
$118K |
| 85045 |
|
25,562 |
20,943 |
$112K |
| 86920 |
|
801 |
580 |
$102K |
| 86850 |
|
4,807 |
3,054 |
$96K |
| 96375 |
|
2,232 |
807 |
$94K |
| 84100 |
|
24,136 |
10,873 |
$90K |
| A9585 |
Gadobutrol injection |
3,473 |
2,533 |
$89K |
| 87635 |
|
2,171 |
1,355 |
$87K |
| 86901 |
|
4,920 |
3,154 |
$78K |
| 82306 |
|
3,155 |
2,650 |
$77K |
| 80048 |
|
4,362 |
2,168 |
$59K |
| 82248 |
|
9,244 |
7,344 |
$49K |
| 82728 |
|
3,480 |
2,791 |
$46K |
| 90471 |
|
1,988 |
1,783 |
$42K |
| 84550 |
|
11,623 |
5,823 |
$42K |
| 96374 |
|
290 |
158 |
$39K |
| J2704 |
Inj, propofol, 10 mg |
10,141 |
3,982 |
$37K |
| 86922 |
|
444 |
303 |
$34K |
| 82610 |
|
2,857 |
2,206 |
$32K |
| 36415 |
|
8,394 |
6,796 |
$30K |
| 99213 |
|
957 |
550 |
$29K |
| 99214 |
|
704 |
492 |
$28K |
| 92018 |
|
58 |
53 |
$25K |
| 83020 |
|
1,561 |
1,363 |
$24K |
| 87536 |
|
421 |
379 |
$20K |
| 96365 |
|
182 |
114 |
$19K |
| 93005 |
|
686 |
583 |
$19K |
| 82043 |
|
1,281 |
1,126 |
$16K |
| 90674 |
|
1,113 |
923 |
$16K |
| 84703 |
|
2,583 |
1,815 |
$15K |
| 86902 |
|
482 |
411 |
$15K |
| 88184 |
|
94 |
73 |
$15K |
| 82570 |
|
1,653 |
1,432 |
$14K |
| J2405 |
Ondansetron hcl injection |
4,929 |
2,040 |
$13K |
| 36592 |
|
964 |
362 |
$11K |
| 90686 |
|
937 |
831 |
$11K |
| 82784 |
|
997 |
663 |
$9K |
| 86361 |
|
224 |
210 |
$8K |
| 99215 |
Prolong outpt/office vis |
178 |
119 |
$8K |
| 97530 |
|
375 |
98 |
$8K |
| 84439 |
|
1,703 |
1,378 |
$8K |
| 92567 |
|
591 |
488 |
$8K |
| 90651 |
|
30 |
29 |
$8K |
| 81003 |
|
4,417 |
3,425 |
$7K |
| 97164 |
|
276 |
229 |
$7K |
| 96361 |
|
111 |
64 |
$7K |
| 86140 |
|
1,982 |
1,140 |
$7K |
| 80050 |
|
825 |
684 |
$7K |
| 87633 |
|
39 |
26 |
$6K |
| 71260 |
|
43 |
40 |
$6K |
| 97168 |
|
200 |
177 |
$5K |
| J9370 |
Vincristine sulfate 1 mg inj |
1,011 |
580 |
$5K |
| 99212 |
|
296 |
177 |
$5K |
| 81001 |
|
1,861 |
1,434 |
$5K |
| 92523 |
|
60 |
54 |
$5K |
| 85027 |
|
1,014 |
656 |
$4K |
| J1200 |
Diphenhydramine hcl injectio |
1,650 |
734 |
$4K |
| 84156 |
|
1,397 |
1,227 |
$4K |
| 92250 |
|
188 |
116 |
$4K |
| 87799 |
|
79 |
26 |
$4K |
| 88108 |
|
252 |
196 |
$4K |
| 82533 |
|
261 |
209 |
$4K |
| 0399T |
|
82 |
73 |
$4K |
| 84466 |
|
404 |
315 |
$4K |
| J3010 |
Fentanyl citrate injection |
2,068 |
1,189 |
$3K |
| 83002 |
|
358 |
306 |
$3K |
| J9250 |
Methotrexate sodium inj |
916 |
316 |
$3K |
| J7050 |
Normal saline solution infus |
2,153 |
749 |
$3K |
| 90661 |
|
171 |
162 |
$3K |
| J7120 |
Ringers lactate infusion |
1,968 |
858 |
$3K |
| 71046 |
|
63 |
52 |
$3K |
| 93888 |
|
33 |
30 |
$3K |
| 87798 |
|
62 |
41 |
$3K |
| 83540 |
|
557 |
457 |
$3K |
| 62270 |
|
14 |
12 |
$2K |
| 88185 |
|
27 |
14 |
$2K |
| Q9966 |
Locm 200-299mg/ml iodine,1ml |
171 |
144 |
$2K |
| 90620 |
|
19 |
14 |
$2K |
| 89051 |
|
557 |
436 |
$2K |
| 87497 |
|
79 |
26 |
$2K |
| 96372 |
|
66 |
36 |
$2K |
| 36591 |
|
249 |
122 |
$2K |
| 87103 |
|
98 |
73 |
$1K |
| 83001 |
|
151 |
132 |
$1K |
| 76376 |
|
229 |
198 |
$1K |
| 92014 |
|
180 |
158 |
$937.60 |
| 87486 |
|
39 |
26 |
$886.12 |
| 87581 |
|
39 |
26 |
$886.12 |
| 80061 |
|
99 |
83 |
$867.73 |
| J1720 |
Hydrocortisone sodium succ i |
119 |
75 |
$811.21 |
| 87040 |
|
96 |
73 |
$697.55 |
| 93356 |
|
271 |
222 |
$686.57 |
| 86360 |
|
24 |
14 |
$676.44 |
| 92133 |
|
29 |
26 |
$657.50 |
| 83525 |
|
103 |
86 |
$627.60 |
| 99211 |
|
79 |
43 |
$563.87 |
| 86355 |
|
24 |
14 |
$538.10 |
| 0202U |
|
107 |
66 |
$531.36 |
| 86357 |
|
24 |
14 |
$528.71 |
| 86359 |
|
24 |
14 |
$528.70 |
| 86706 |
|
62 |
53 |
$480.63 |
| 84443 |
|
43 |
37 |
$469.62 |
| J7060 |
5% dextrose/water |
594 |
226 |
$447.20 |
| 96411 |
|
18 |
12 |
$405.34 |
| 87535 |
|
12 |
12 |
$361.14 |
| J2001 |
Lidocaine injection |
261 |
184 |
$354.26 |
| 90734 |
|
27 |
27 |
$311.80 |
| 92552 |
|
29 |
25 |
$272.32 |
| J9100 |
Cytarabine hcl 100 mg inj |
103 |
37 |
$226.86 |
| J0696 |
Ceftriaxone sodium injection |
74 |
60 |
$199.89 |
| 87340 |
|
32 |
28 |
$184.45 |
| 82670 |
|
14 |
13 |
$161.04 |
| 84305 |
|
24 |
12 |
$160.70 |
| J7030 |
Normal saline solution infus |
226 |
127 |
$151.27 |
| 90472 |
|
14 |
14 |
$145.65 |
| 82330 |
|
13 |
12 |
$139.09 |
| 90685 |
|
24 |
15 |
$136.26 |
| G0463 |
Hospital outpt clinic visit |
48 |
18 |
$131.58 |
| A4618 |
Breathing circuits |
92 |
49 |
$97.96 |
| J1626 |
Granisetron hcl injection |
30 |
18 |
$95.83 |
| 86704 |
|
13 |
13 |
$95.22 |
| 85730 |
|
18 |
16 |
$70.24 |
| 83036 |
|
14 |
12 |
$60.51 |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
25 |
24 |
$53.35 |
| 92556 |
|
28 |
25 |
$53.10 |
| S0080 |
Injection, pentamidine iseth |
32 |
26 |
$52.29 |
| 85610 |
|
16 |
14 |
$34.56 |
| J9260 |
Inj methotrexate sodium 50mg |
21 |
12 |
$24.09 |
| J7040 |
Normal saline solution infus |
35 |
25 |
$11.45 |
| J1100 |
Dexamethasone sodium phos |
28 |
14 |
$3.64 |