| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J2426 |
Inj, invega sustenna, 1 mg |
13,096 |
11,223 |
$10.39M |
| J0401 |
Inj, abilify maintena, 1 mg |
2,002 |
1,695 |
$1.76M |
| G0463 |
Hospital outpt clinic visit |
79,547 |
68,285 |
$1.64M |
| G0378 |
Hospital observation per hr |
6,376 |
2,619 |
$1.52M |
| 99285 |
|
3,111 |
2,727 |
$1.12M |
| 99283 |
|
2,823 |
2,367 |
$1.01M |
| Q3014 |
Telehealth facility fee |
26,138 |
23,928 |
$603K |
| 99284 |
|
1,379 |
1,182 |
$503K |
| J2794 |
Inj risperdal consta, 0.5 mg |
1,395 |
761 |
$440K |
| 90837 |
|
13,788 |
9,668 |
$292K |
| 96372 |
|
32,390 |
26,560 |
$220K |
| J3490 |
Drugs unclassified injection |
27,896 |
2,429 |
$152K |
| J1631 |
Haloperidol decanoate inj |
6,630 |
5,648 |
$149K |
| 80305 |
|
5,208 |
4,384 |
$133K |
| 90791 |
|
2,794 |
2,712 |
$91K |
| 87636 |
|
1,472 |
1,124 |
$87K |
| 90833 |
|
2,480 |
2,201 |
$84K |
| 90792 |
|
1,505 |
1,387 |
$64K |
| J8499 |
Oral prescrip drug non chemo |
12,873 |
869 |
$53K |
| 90832 |
|
2,184 |
1,786 |
$35K |
| 80053 |
|
1,391 |
1,298 |
$27K |
| 90834 |
|
1,100 |
947 |
$22K |
| 80061 |
|
1,219 |
1,155 |
$17K |
| 99282 |
|
202 |
156 |
$16K |
| 85025 |
|
1,067 |
984 |
$13K |
| 82306 |
|
614 |
573 |
$13K |
| 84443 |
|
676 |
630 |
$13K |
| 93005 |
|
184 |
179 |
$10K |
| 83036 |
|
1,344 |
1,272 |
$10K |
| 84439 |
|
645 |
598 |
$10K |
| 81025 |
|
657 |
585 |
$9K |
| 82607 |
|
531 |
497 |
$6K |
| 0241U |
|
48 |
44 |
$5K |
| 90670 |
|
30 |
29 |
$4K |
| 82746 |
|
328 |
299 |
$3K |
| 82962 |
|
1,567 |
1,395 |
$3K |
| U0003 |
Cov-19 amp prb hgh thruput |
71 |
68 |
$3K |
| 90471 |
|
118 |
117 |
$2K |
| 82075 |
|
277 |
247 |
$2K |
| 87635 |
|
48 |
40 |
$1K |
| 99281 |
|
28 |
27 |
$1K |
| 90853 |
|
51 |
25 |
$1K |
| 80307 |
|
17 |
16 |
$1K |
| J2680 |
Fluphenazine decanoate 25 mg |
137 |
91 |
$967.11 |
| 84146 |
|
52 |
51 |
$790.95 |
| 90836 |
|
20 |
14 |
$713.10 |
| 99199 |
|
120 |
120 |
$625.00 |
| 90686 |
|
143 |
139 |
$511.16 |
| 85027 |
|
114 |
97 |
$477.74 |
| 82728 |
|
41 |
41 |
$351.25 |
| 90847 |
|
32 |
28 |
$251.70 |
| 81002 |
|
29 |
28 |
$147.74 |
| 86803 |
|
13 |
12 |
$112.08 |
| 83735 |
|
15 |
13 |
$78.93 |
| 36415 |
|
31 |
28 |
$35.42 |
| H0040 |
Assert comm tx pgm per diem |
1,103 |
240 |
$0.00 |
| 90674 |
|
12 |
12 |
$0.00 |