| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| Z7502 |
|
17,471 |
17,318 |
$641K |
| Z7610 |
|
4,327 |
3,188 |
$48K |
| 85027 |
|
4,120 |
3,813 |
$18K |
| 80053 |
|
1,919 |
1,831 |
$15K |
| 0450 |
|
1,960 |
1,795 |
$11K |
| 93005 |
|
1,318 |
1,235 |
$7K |
| 87426 |
|
225 |
223 |
$6K |
| 70450 |
|
265 |
257 |
$4K |
| J3490 |
Drugs unclassified injection |
3,051 |
1,063 |
$3K |
| 83690 |
|
1,024 |
980 |
$3K |
| 36415 |
|
495 |
431 |
$3K |
| T1999 |
Noc retail items andsupplies |
34 |
14 |
$2K |
| 96374 |
|
407 |
390 |
$2K |
| 96372 |
|
155 |
138 |
$2K |
| 71045 |
|
942 |
899 |
$2K |
| 84484 |
|
1,176 |
970 |
$1K |
| 74177 |
|
96 |
93 |
$1K |
| 81001 |
|
730 |
712 |
$1K |
| 80047 |
|
761 |
722 |
$1K |
| U0002 |
Covid-19 lab test non-cdc |
13 |
13 |
$654.20 |
| 87400 |
|
61 |
60 |
$553.29 |
| J7030 |
Normal saline solution infus |
496 |
426 |
$535.71 |
| 87651 |
|
13 |
13 |
$517.01 |
| 80076 |
|
613 |
586 |
$515.82 |
| 87086 |
|
169 |
167 |
$377.96 |
| 81025 |
|
32 |
32 |
$366.04 |
| 96361 |
|
131 |
123 |
$343.92 |
| 82550 |
|
651 |
571 |
$213.49 |
| 83605 |
|
234 |
193 |
$197.89 |
| 96360 |
|
37 |
37 |
$182.78 |
| J1885 |
Ketorolac tromethamine inj |
63 |
44 |
$144.28 |
| 96375 |
|
48 |
45 |
$108.00 |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
181 |
153 |
$97.69 |
| 87040 |
|
179 |
111 |
$87.07 |
| 0360 |
|
14 |
12 |
$86.48 |
| 85610 |
|
214 |
200 |
$79.42 |
| 80048 |
|
119 |
117 |
$79.10 |
| 84702 |
|
17 |
16 |
$78.83 |
| 83880 |
|
55 |
54 |
$75.27 |
| J2405 |
Ondansetron hcl injection |
66 |
64 |
$67.88 |
| 81003 |
|
81 |
80 |
$59.39 |
| J0696 |
Ceftriaxone sodium injection |
35 |
31 |
$31.90 |
| 85730 |
|
81 |
80 |
$25.00 |
| 83735 |
|
104 |
91 |
$10.25 |
| 84443 |
|
29 |
29 |
$7.62 |
| J2270 |
Morphine sulfate injection |
15 |
15 |
$6.50 |
| 87077 |
|
14 |
12 |
$0.00 |
| 0270 |
|
49 |
32 |
$0.00 |
| Q0162 |
Ondansetron oral |
13 |
13 |
$0.00 |
| 74176 |
|
12 |
12 |
$0.00 |
| J7040 |
Normal saline solution infus |
13 |
13 |
$0.00 |
| 87186 |
|
15 |
12 |
$0.00 |