| Code | Description | Claims | Beneficiaries | Total Paid |
| 0450 |
|
52,613 |
46,606 |
$3.18M |
| 97139 |
|
40,132 |
7,664 |
$721K |
| 96374 |
|
9,247 |
8,472 |
$596K |
| 74177 |
|
3,123 |
3,043 |
$563K |
| 99285 |
|
3,859 |
3,520 |
$554K |
| 99284 |
|
7,244 |
6,424 |
$538K |
| 92507 |
|
10,760 |
3,766 |
$530K |
| 70450 |
|
3,681 |
3,558 |
$512K |
| 85025 |
|
47,335 |
42,411 |
$394K |
| 80053 |
|
36,433 |
33,887 |
$389K |
| 93005 |
|
14,831 |
13,643 |
$373K |
| 87635 |
|
7,425 |
7,136 |
$369K |
| 80307 |
|
5,873 |
5,269 |
$350K |
| 77067 |
|
5,242 |
5,236 |
$340K |
| 99283 |
|
4,849 |
4,403 |
$241K |
| 97799 |
|
12,847 |
2,340 |
$239K |
| 84443 |
|
14,135 |
13,878 |
$225K |
| 96375 |
|
5,791 |
5,135 |
$222K |
| 97750 |
|
5,242 |
2,961 |
$184K |
| 87637 |
|
1,089 |
1,079 |
$171K |
| 96372 |
|
5,653 |
4,403 |
$163K |
| 87502 |
|
2,361 |
2,320 |
$156K |
| 99281 |
|
3,051 |
2,443 |
$154K |
| 96365 |
|
2,274 |
1,854 |
$149K |
| 80061 |
|
17,450 |
17,332 |
$148K |
| 71046 |
|
6,530 |
6,347 |
$143K |
| 87636 |
|
810 |
808 |
$142K |
| 96361 |
|
4,343 |
3,950 |
$141K |
| 83036 |
|
15,732 |
15,615 |
$139K |
| 87633 |
|
400 |
396 |
$138K |
| 76856 |
|
2,045 |
2,024 |
$135K |
| U0003 |
Cov-19 amp prb hgh thruput |
2,410 |
2,348 |
$134K |
| 86481 |
|
2,090 |
2,085 |
$131K |
| 90791 |
|
1,112 |
854 |
$128K |
| 74176 |
|
1,348 |
1,329 |
$128K |
| 87591 |
|
2,023 |
2,000 |
$127K |
| 87491 |
|
2,031 |
2,009 |
$127K |
| 71045 |
|
9,030 |
8,499 |
$124K |
| 73721 |
|
338 |
314 |
$118K |
| 80048 |
|
14,516 |
13,400 |
$112K |
| 97110 |
|
12,979 |
4,663 |
$112K |
| 76700 |
|
1,603 |
1,586 |
$109K |
| 76830 |
|
1,534 |
1,522 |
$104K |
| 84484 |
|
8,977 |
6,871 |
$102K |
| 96360 |
|
1,569 |
1,510 |
$102K |
| 82306 |
|
5,733 |
5,693 |
$102K |
| 76641 |
|
1,551 |
1,537 |
$97K |
| 77063 |
|
5,238 |
5,232 |
$87K |
| 70551 |
|
215 |
208 |
$80K |
| 97140 |
|
9,141 |
3,392 |
$74K |
| 99199 |
|
947 |
752 |
$73K |
| 87651 |
|
1,133 |
1,125 |
$69K |
| 83690 |
|
7,187 |
6,712 |
$68K |
| 97113 |
|
2,557 |
669 |
$68K |
| 76705 |
|
1,230 |
1,219 |
$67K |
| 71275 |
|
424 |
414 |
$67K |
| 81001 |
|
18,189 |
17,230 |
$63K |
| 77066 |
Tomosynthesis, mammo |
647 |
644 |
$62K |
| 77080 |
|
4,253 |
4,240 |
$57K |
| 87086 |
|
7,340 |
6,992 |
$54K |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
5,505 |
5,039 |
$51K |
| 72148 |
|
128 |
128 |
$49K |
| 93970 |
|
292 |
287 |
$49K |
| J7030 |
Normal saline solution infus |
6,344 |
5,567 |
$48K |
| 87040 |
|
3,884 |
2,213 |
$46K |
| 99070 |
|
18,318 |
10,425 |
$46K |
| 84439 |
|
5,255 |
5,196 |
$44K |
| 86803 |
|
1,772 |
1,765 |
$43K |
| 93306 |
|
251 |
251 |
$41K |
| 87389 |
|
1,891 |
1,885 |
$39K |
| 83880 |
|
2,864 |
2,689 |
$38K |
| J3490 |
Drugs unclassified injection |
7,027 |
3,910 |
$38K |
| 73030 |
|
1,551 |
1,522 |
$38K |
| 81025 |
|
4,368 |
4,236 |
$36K |
| 71250 |
|
280 |
279 |
$35K |
| 71260 |
|
239 |
238 |
$35K |
| G0108 |
Diab manage trn per indiv |
501 |
263 |
$35K |
| 87486 |
|
603 |
596 |
$35K |
| 87581 |
|
601 |
594 |
$35K |
| 73610 |
|
1,244 |
1,211 |
$34K |
| 76805 |
|
314 |
312 |
$33K |
| G0279 |
Tomosynthesis, mammo |
1,609 |
1,601 |
$32K |
| 83605 |
|
2,862 |
2,300 |
$32K |
| 72100 |
|
1,152 |
1,139 |
$32K |
| 87186 |
|
3,766 |
3,342 |
$31K |
| 72125 |
|
159 |
159 |
$31K |
| 82077 |
|
1,540 |
1,388 |
$31K |
| 86480 |
|
511 |
509 |
$30K |
| 83970 |
|
1,943 |
1,903 |
$29K |
| 73630 |
|
1,135 |
1,112 |
$28K |
| 73562 |
|
1,110 |
1,096 |
$26K |
| 85027 |
|
5,186 |
5,055 |
$25K |
| 94640 |
|
1,044 |
899 |
$24K |
| J2405 |
Ondansetron hcl injection |
3,974 |
3,512 |
$23K |
| 85379 |
|
1,755 |
1,719 |
$23K |
| 0750 |
|
116 |
116 |
$21K |
| 81003 |
|
8,370 |
8,167 |
$21K |
| 97530 |
|
3,294 |
1,489 |
$21K |
| J1885 |
Ketorolac tromethamine inj |
3,113 |
2,926 |
$20K |
| 97165 |
|
515 |
271 |
$20K |
| 77065 |
Tomosynthesis, mammo |
258 |
257 |
$19K |
| 99282 |
|
543 |
502 |
$19K |
| 71271 |
|
226 |
226 |
$19K |
| 85610 |
|
5,209 |
4,376 |
$18K |
| J7120 |
Ringers lactate infusion |
2,070 |
1,902 |
$18K |
| 82947 |
|
5,076 |
2,873 |
$17K |
| 82728 |
|
2,477 |
2,382 |
$17K |
| 87634 |
|
293 |
284 |
$17K |
| 76770 |
|
252 |
249 |
$17K |
| 75574 |
|
78 |
78 |
$16K |
| 83735 |
|
2,761 |
2,387 |
$15K |
| A9585 |
Gadobutrol injection |
689 |
617 |
$15K |
| 73130 |
|
606 |
599 |
$15K |
| J1170 |
Hydromorphone injection |
1,699 |
1,391 |
$15K |
| 84145 |
|
1,027 |
926 |
$15K |
| 78452 |
|
51 |
49 |
$14K |
| U0005 |
Infec agen detec ampli probe |
1,133 |
1,107 |
$14K |
| 87077 |
|
3,578 |
3,073 |
$14K |
| 76536 |
|
290 |
288 |
$14K |
| 82043 |
|
4,454 |
4,414 |
$12K |
| 85730 |
|
1,690 |
1,608 |
$12K |
| 87340 |
|
571 |
568 |
$12K |
| 86140 |
|
2,097 |
1,995 |
$12K |
| J0696 |
Ceftriaxone sodium injection |
1,589 |
1,470 |
$12K |
| 82570 |
|
5,304 |
4,877 |
$11K |
| 86850 |
|
1,142 |
1,091 |
$10K |
| 83540 |
|
3,016 |
2,912 |
$10K |
| J1200 |
Diphenhydramine hcl injectio |
1,610 |
1,441 |
$10K |
| J2060 |
Lorazepam injection |
1,599 |
1,366 |
$10K |
| 87430 |
|
626 |
620 |
$10K |
| J2270 |
Morphine sulfate injection |
1,145 |
1,013 |
$9K |
| 80076 |
|
1,334 |
1,302 |
$9K |
| 87081 |
|
941 |
928 |
$9K |
| 84460 |
|
2,532 |
2,514 |
$9K |
| 83550 |
|
2,766 |
2,665 |
$9K |
| 84153 |
|
1,106 |
1,097 |
$9K |
| 73502 |
|
442 |
434 |
$9K |
| 84450 |
|
2,367 |
2,349 |
$9K |
| 76642 |
|
173 |
173 |
$9K |
| 87070 |
|
1,106 |
993 |
$8K |
| T1999 |
Noc retail items andsupplies |
813 |
444 |
$8K |
| 76801 |
|
124 |
111 |
$7K |
| 82274 |
|
1,782 |
1,766 |
$7K |
| 86901 |
|
1,329 |
1,259 |
$7K |
| 73564 |
|
222 |
220 |
$7K |
| 0270 |
|
259 |
71 |
$7K |
| 85652 |
|
2,968 |
2,840 |
$6K |
| J2765 |
Metoclopramide hcl injection |
782 |
693 |
$6K |
| 0762 |
|
121 |
56 |
$6K |
| 80069 |
|
1,940 |
1,859 |
$6K |
| 73110 |
|
220 |
215 |
$6K |
| 84550 |
|
2,561 |
2,496 |
$6K |
| 93971 |
|
64 |
64 |
$5K |
| 82550 |
|
1,254 |
1,200 |
$5K |
| 70496 |
|
25 |
25 |
$5K |
| 86900 |
|
1,393 |
1,261 |
$5K |
| 93017 |
|
99 |
95 |
$5K |
| 73560 |
|
257 |
250 |
$4K |
| 86704 |
|
165 |
165 |
$4K |
| 73221 |
|
12 |
12 |
$4K |
| 86765 |
|
175 |
173 |
$4K |
| 88175 |
|
845 |
840 |
$4K |
| 86735 |
|
157 |
156 |
$4K |
| 86762 |
|
175 |
174 |
$4K |
| 87624 |
|
137 |
134 |
$4K |
| 84100 |
|
1,164 |
893 |
$4K |
| 86706 |
|
151 |
151 |
$3K |
| 73140 |
|
177 |
173 |
$3K |
| A9502 |
Tc99m tetrofosmin |
24 |
24 |
$3K |
| 97161 |
|
133 |
128 |
$3K |
| 97162 |
|
163 |
156 |
$3K |
| 93798 |
|
147 |
28 |
$3K |
| 83655 |
|
500 |
499 |
$3K |
| 87798 |
|
46 |
43 |
$3K |
| Z7502 |
|
78 |
78 |
$3K |
| J1100 |
Dexamethasone sodium phos |
444 |
397 |
$3K |
| 82607 |
|
2,404 |
2,390 |
$3K |
| 84075 |
|
946 |
943 |
$3K |
| 92508 |
|
97 |
37 |
$3K |
| 92522 |
|
30 |
30 |
$3K |
| 86592 |
|
448 |
446 |
$3K |
| 92523 |
|
29 |
29 |
$2K |
| 88305 |
|
143 |
106 |
$2K |
| 87045 |
|
136 |
130 |
$2K |
| 87804 |
|
284 |
178 |
$2K |
| 82951 |
|
83 |
83 |
$2K |
| 74018 |
|
97 |
95 |
$2K |
| 86787 |
|
62 |
62 |
$2K |
| 82565 |
|
696 |
676 |
$2K |
| 87400 |
|
319 |
317 |
$1K |
| 77336 |
|
50 |
24 |
$1K |
| 84156 |
|
1,397 |
1,330 |
$1K |
| 87517 |
|
19 |
18 |
$1K |
| 81220 |
|
12 |
12 |
$1K |
| 96366 |
|
39 |
37 |
$1K |
| 87075 |
|
203 |
185 |
$1K |
| 97116 |
|
296 |
164 |
$1K |
| 87205 |
|
470 |
423 |
$1K |
| 92610 |
|
51 |
48 |
$1K |
| 93270 |
|
24 |
24 |
$1K |
| J3010 |
Fentanyl citrate injection |
153 |
142 |
$1K |
| 36415 |
|
28,607 |
24,904 |
$1K |
| 96413 |
|
20 |
12 |
$1K |
| 73080 |
|
40 |
40 |
$1K |
| 72040 |
|
40 |
40 |
$997.01 |
| 87147 |
|
167 |
102 |
$906.06 |
| 80143 |
|
54 |
53 |
$865.00 |
| 87480 |
|
26 |
26 |
$744.22 |
| J2250 |
Inj midazolam hydrochloride |
121 |
114 |
$742.91 |
| U0002 |
Covid-19 lab test non-cdc |
18 |
18 |
$718.34 |
| 87510 |
|
26 |
26 |
$715.81 |
| 87046 |
|
200 |
130 |
$633.76 |
| J1815 |
Insulin injection |
20 |
12 |
$615.25 |
| 80055 |
|
12 |
12 |
$589.82 |
| 87088 |
|
79 |
79 |
$555.03 |
| 84702 |
|
30 |
26 |
$528.27 |
| 82803 |
|
13 |
13 |
$514.60 |
| 71020 |
|
12 |
12 |
$490.29 |
| 87420 |
|
31 |
30 |
$471.83 |
| 86038 |
|
25 |
25 |
$444.89 |
| 85007 |
|
409 |
391 |
$408.66 |
| 86769 |
|
13 |
12 |
$404.87 |
| 80179 |
|
26 |
26 |
$404.79 |
| J7050 |
Normal saline solution infus |
104 |
66 |
$399.11 |
| 87660 |
|
26 |
26 |
$397.81 |
| 90715 |
|
12 |
12 |
$352.99 |
| 97112 |
|
61 |
25 |
$337.24 |
| J7040 |
Normal saline solution infus |
93 |
69 |
$284.77 |
| 82746 |
|
36 |
36 |
$277.90 |
| 86695 |
|
13 |
12 |
$270.75 |
| J0780 |
Prochlorperazine injection |
15 |
12 |
$259.37 |
| 94726 |
|
12 |
12 |
$248.97 |
| 86696 |
|
13 |
12 |
$222.77 |
| 94729 |
|
12 |
12 |
$203.92 |
| J1630 |
Haloperidol injection |
59 |
36 |
$184.36 |
| 82247 |
|
27 |
25 |
$179.97 |
| J0137 |
Inj, acetaminophen (hikma) |
23 |
12 |
$150.00 |
| 0250 |
|
14 |
12 |
$129.76 |
| 82248 |
|
15 |
12 |
$111.41 |
| 82040 |
|
27 |
27 |
$75.20 |
| 84480 |
|
13 |
12 |
$66.92 |
| 83615 |
|
17 |
12 |
$57.95 |
| Q9965 |
Locm 100-199mg/ml iodine,1ml |
56 |
36 |
$53.20 |
| 85018 |
|
13 |
12 |
$37.30 |
| G8978 |
Mobility current status |
197 |
193 |
$0.00 |
| G8979 |
Mobility goal status |
276 |
264 |
$0.00 |
| G8980 |
Mobility d/c status |
31 |
29 |
$0.00 |
| G0378 |
Hospital observation per hr |
44 |
37 |
$0.00 |