| Code | Description | Claims | Beneficiaries | Total Paid |
| X4011 |
|
8,245 |
7,601 |
$2.82M |
| G0463 |
Hospital outpt clinic visit |
35,859 |
29,866 |
$2.45M |
| 99284 |
|
10,443 |
9,803 |
$1.88M |
| 99283 |
|
11,277 |
10,594 |
$1.39M |
| H2018 |
Psysoc rehab svc, per diem |
18,394 |
651 |
$946K |
| 85025 |
|
37,403 |
32,789 |
$935K |
| 80053 |
|
31,540 |
27,981 |
$802K |
| 81002 |
|
23,611 |
18,802 |
$552K |
| 76816 |
|
7,469 |
7,218 |
$469K |
| 99213 |
|
13,241 |
10,916 |
$432K |
| 99211 |
|
5,045 |
4,498 |
$403K |
| 76818 |
|
6,305 |
4,140 |
$360K |
| 93005 |
|
3,869 |
3,593 |
$315K |
| X4003 |
|
2,837 |
1,955 |
$284K |
| X4006 |
|
137 |
107 |
$284K |
| 96374 |
|
2,107 |
1,975 |
$238K |
| 76811 |
|
2,316 |
2,285 |
$204K |
| 59025 |
|
1,956 |
1,270 |
$197K |
| U0003 |
Cov-19 amp prb hgh thruput |
3,765 |
3,458 |
$194K |
| 87591 |
|
4,676 |
4,586 |
$172K |
| 87491 |
|
4,617 |
4,527 |
$172K |
| 86850 |
|
4,776 |
4,722 |
$163K |
| 99212 |
|
3,431 |
3,109 |
$158K |
| 85027 |
|
6,303 |
6,143 |
$154K |
| 86592 |
|
4,900 |
4,860 |
$137K |
| 87086 |
|
5,798 |
5,611 |
$136K |
| Y7506 |
|
934 |
424 |
$110K |
| 81025 |
|
1,450 |
1,402 |
$95K |
| 76815 |
|
2,015 |
1,852 |
$91K |
| 71045 |
|
1,832 |
1,710 |
$83K |
| 76819 |
|
1,192 |
932 |
$82K |
| 76820 |
|
1,106 |
705 |
$75K |
| 76805 |
|
1,321 |
1,313 |
$72K |
| 87389 |
|
2,644 |
2,623 |
$72K |
| 81003 |
|
2,677 |
2,460 |
$72K |
| 77386 |
|
296 |
24 |
$71K |
| 96413 |
|
518 |
279 |
$68K |
| 86803 |
|
3,480 |
3,455 |
$68K |
| 84443 |
|
5,851 |
5,737 |
$66K |
| 84484 |
|
1,093 |
965 |
$63K |
| 80307 |
|
1,428 |
1,409 |
$63K |
| 81513 |
|
558 |
545 |
$61K |
| 86900 |
|
2,002 |
1,984 |
$57K |
| 80061 |
|
4,881 |
4,788 |
$54K |
| 86901 |
|
2,004 |
1,985 |
$50K |
| U0005 |
Infec agen detec ampli probe |
2,771 |
2,604 |
$49K |
| 77334 |
|
101 |
85 |
$46K |
| 87340 |
|
2,032 |
2,017 |
$43K |
| 87801 |
|
877 |
866 |
$40K |
| 82306 |
|
1,968 |
1,935 |
$39K |
| 83690 |
|
470 |
454 |
$38K |
| 80048 |
|
1,611 |
1,443 |
$36K |
| 80081 |
|
657 |
653 |
$35K |
| 77412 |
|
161 |
26 |
$34K |
| 86762 |
|
1,157 |
1,149 |
$31K |
| 82950 |
|
2,143 |
2,131 |
$30K |
| 81001 |
|
783 |
717 |
$29K |
| 86481 |
|
394 |
389 |
$28K |
| 62323 |
|
94 |
86 |
$28K |
| 87660 |
|
2,169 |
2,115 |
$27K |
| G0480 |
Drug test def 1-7 classes |
321 |
266 |
$27K |
| 83036 |
|
3,151 |
3,097 |
$24K |
| 80305 |
|
234 |
149 |
$24K |
| 77336 |
|
379 |
191 |
$23K |
| 87480 |
|
1,669 |
1,634 |
$22K |
| 82728 |
|
2,125 |
2,099 |
$21K |
| 84702 |
|
333 |
313 |
$20K |
| 82607 |
|
1,890 |
1,873 |
$19K |
| 86480 |
|
383 |
379 |
$18K |
| 84466 |
|
1,918 |
1,900 |
$17K |
| 86780 |
|
1,900 |
1,876 |
$16K |
| 76817 |
|
261 |
227 |
$16K |
| 87481 |
|
534 |
522 |
$15K |
| 87081 |
|
2,285 |
2,264 |
$14K |
| 87636 |
|
170 |
158 |
$13K |
| 87497 |
|
879 |
663 |
$13K |
| 99282 |
|
202 |
194 |
$13K |
| 92507 |
|
213 |
78 |
$12K |
| 87799 |
|
842 |
599 |
$12K |
| 84439 |
|
1,967 |
1,929 |
$12K |
| 82746 |
|
1,118 |
1,109 |
$11K |
| Y7507 |
|
135 |
65 |
$11K |
| 99285 |
|
29 |
28 |
$11K |
| 83540 |
|
2,142 |
2,117 |
$10K |
| 87510 |
|
804 |
786 |
$10K |
| 85610 |
|
1,282 |
943 |
$10K |
| 96372 |
|
248 |
236 |
$9K |
| 87661 |
|
323 |
321 |
$9K |
| 99214 |
|
264 |
256 |
$9K |
| 99281 |
|
196 |
186 |
$8K |
| 87077 |
|
1,304 |
1,254 |
$8K |
| 70450 |
|
69 |
64 |
$7K |
| 83735 |
|
2,178 |
1,658 |
$6K |
| 80069 |
|
1,778 |
1,280 |
$6K |
| 71046 |
|
51 |
48 |
$5K |
| 80197 |
|
1,179 |
842 |
$5K |
| 84403 |
|
230 |
227 |
$5K |
| 82105 |
|
203 |
202 |
$4K |
| 96361 |
|
89 |
87 |
$4K |
| 83021 |
|
28 |
28 |
$4K |
| 87186 |
|
639 |
607 |
$4K |
| 74177 |
|
13 |
12 |
$3K |
| 84481 |
|
245 |
242 |
$3K |
| 90471 |
|
67 |
66 |
$3K |
| J3490 |
Drugs unclassified injection |
435 |
177 |
$3K |
| 83001 |
|
192 |
185 |
$3K |
| 82570 |
|
719 |
713 |
$2K |
| 82670 |
|
114 |
109 |
$2K |
| 88175 |
|
171 |
170 |
$2K |
| 82043 |
|
592 |
589 |
$2K |
| 86140 |
|
570 |
527 |
$2K |
| 20610 |
|
14 |
13 |
$2K |
| 86038 |
|
232 |
231 |
$2K |
| 84156 |
|
1,402 |
1,030 |
$2K |
| A9552 |
F18 fdg |
27 |
27 |
$2K |
| 96365 |
|
44 |
25 |
$2K |
| 84153 |
|
131 |
130 |
$2K |
| 76801 |
|
52 |
52 |
$2K |
| 86336 |
|
25 |
25 |
$2K |
| 96375 |
|
40 |
38 |
$2K |
| 86300 |
|
41 |
36 |
$1K |
| 77300 |
|
15 |
12 |
$1K |
| 87015 |
|
208 |
207 |
$1K |
| Q3014 |
Telehealth facility fee |
139 |
136 |
$1K |
| 85652 |
|
466 |
442 |
$913.16 |
| 82677 |
|
12 |
12 |
$880.32 |
| 87635 |
|
33 |
27 |
$870.10 |
| 83605 |
|
81 |
78 |
$657.90 |
| 83020 |
|
159 |
156 |
$616.35 |
| 36591 |
|
14 |
12 |
$581.00 |
| 84146 |
|
42 |
41 |
$577.94 |
| 84163 |
|
13 |
13 |
$445.76 |
| 87804 |
|
16 |
16 |
$389.80 |
| 84425 |
|
25 |
25 |
$377.63 |
| 83880 |
|
13 |
12 |
$302.23 |
| 82977 |
|
71 |
62 |
$297.75 |
| 81015 |
|
133 |
130 |
$294.18 |
| 82951 |
|
26 |
26 |
$255.81 |
| 86706 |
|
32 |
32 |
$241.51 |
| 80076 |
|
43 |
39 |
$235.01 |
| 84144 |
|
18 |
13 |
$234.17 |
| 36415 |
|
4,265 |
3,509 |
$201.13 |
| 84100 |
|
72 |
62 |
$200.86 |
| 86696 |
|
12 |
12 |
$171.44 |
| 82784 |
|
13 |
13 |
$167.96 |
| 83002 |
|
12 |
12 |
$162.91 |
| 86376 |
|
13 |
13 |
$151.32 |
| 85384 |
|
17 |
14 |
$138.52 |
| J7030 |
Normal saline solution infus |
42 |
38 |
$134.88 |
| 85730 |
|
29 |
28 |
$120.98 |
| 86695 |
|
12 |
12 |
$116.84 |
| 87147 |
|
12 |
12 |
$111.78 |
| 82962 |
|
52 |
31 |
$103.53 |
| 86431 |
|
14 |
14 |
$63.42 |
| 82550 |
|
23 |
20 |
$60.94 |
| 87210 |
|
12 |
12 |
$51.15 |
| 82952 |
|
13 |
13 |
$37.56 |
| 84460 |
|
24 |
24 |
$26.55 |
| 84075 |
|
24 |
24 |
$25.95 |
| 84450 |
|
24 |
24 |
$25.94 |
| 82248 |
|
12 |
12 |
$25.15 |
| 82247 |
|
24 |
24 |
$25.15 |
| J3010 |
Fentanyl citrate injection |
35 |
29 |
$21.34 |
| 84155 |
|
24 |
24 |
$18.50 |
| J2405 |
Ondansetron hcl injection |
13 |
12 |
$10.60 |
| J1885 |
Ketorolac tromethamine inj |
18 |
12 |
$3.61 |
| A9270 |
Non-covered item or service |
30 |
28 |
$0.00 |
| J2704 |
Inj, propofol, 10 mg |
13 |
12 |
$0.00 |
| G0008 |
Admin influenza virus vac |
47 |
44 |
$0.00 |