| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 0450 |
|
294,185 |
248,579 |
$6.83M |
| J3490 |
Drugs unclassified injection |
200,945 |
78,920 |
$4.49M |
| 99199 |
|
46,111 |
43,952 |
$4.12M |
| T1999 |
Noc retail items andsupplies |
42,665 |
15,537 |
$3.62M |
| 80047 |
|
175,041 |
159,589 |
$2.52M |
| Z7502 |
|
26,185 |
25,770 |
$988K |
| Z9725 |
|
15,420 |
15,334 |
$663K |
| 0360 |
|
14,354 |
12,383 |
$549K |
| G0378 |
Hospital observation per hr |
1,848 |
894 |
$538K |
| 93303 |
|
5,382 |
4,619 |
$502K |
| 87491 |
|
35,019 |
33,872 |
$448K |
| 87591 |
|
35,008 |
33,861 |
$428K |
| 0761 |
|
39,642 |
31,096 |
$414K |
| 96374 |
|
47,587 |
43,608 |
$401K |
| 93010 |
|
170,848 |
144,677 |
$396K |
| Z7500 |
|
10,964 |
9,869 |
$373K |
| 93325 |
|
6,282 |
5,347 |
$354K |
| 0206 |
|
569 |
507 |
$327K |
| 85025 |
|
267,298 |
235,055 |
$308K |
| U0002 |
Covid-19 lab test non-cdc |
38,852 |
37,074 |
$295K |
| 96112 |
|
1,690 |
1,690 |
$273K |
| 93320 |
|
5,271 |
4,495 |
$239K |
| 96372 |
|
39,472 |
29,436 |
$226K |
| Z4300 |
|
2,161 |
2,161 |
$222K |
| 90999 |
|
6,139 |
680 |
$206K |
| 0510 |
|
11,900 |
9,771 |
$192K |
| 87389 |
|
30,006 |
29,030 |
$190K |
| J2505 |
Injection, pegfilgrastim 6mg |
314 |
230 |
$183K |
| Z4304 |
|
2,156 |
2,156 |
$166K |
| 96379 |
|
2,282 |
1,308 |
$165K |
| 97139 |
|
26,752 |
5,652 |
$161K |
| 93005 |
|
84,815 |
76,171 |
$160K |
| Z7610 |
|
19,653 |
10,622 |
$160K |
| J9035 |
Bevacizumab injection |
531 |
297 |
$148K |
| 86850 |
|
23,794 |
23,030 |
$136K |
| 74177 |
|
15,313 |
14,916 |
$121K |
| 86780 |
|
37,921 |
35,953 |
$114K |
| 71046 |
|
43,823 |
41,690 |
$114K |
| 70450 |
|
17,193 |
16,472 |
$107K |
| A4217 |
Sterile water/saline, 500 ml |
3,930 |
3,795 |
$107K |
| 93306 |
|
6,457 |
6,285 |
$107K |
| 70553 |
|
1,125 |
1,108 |
$102K |
| 99283 |
|
5,038 |
4,360 |
$96K |
| 81001 |
|
106,878 |
99,161 |
$92K |
| 0160 |
|
18,688 |
10,002 |
$89K |
| 95911 |
|
4,625 |
3,437 |
$86K |
| 0710 |
|
8,730 |
8,371 |
$86K |
| 97750 |
|
10,336 |
7,211 |
$85K |
| 97110 |
|
34,317 |
12,511 |
$81K |
| 88305 |
|
6,532 |
6,309 |
$80K |
| 0270 |
|
290,884 |
115,809 |
$79K |
| 81025 |
|
15,010 |
14,551 |
$79K |
| 77067 |
|
8,605 |
8,565 |
$78K |
| J7030 |
Normal saline solution infus |
37,001 |
31,432 |
$77K |
| 97799 |
|
9,481 |
1,699 |
$76K |
| 0760 |
|
29,129 |
25,546 |
$74K |
| 83036 |
|
51,428 |
49,969 |
$72K |
| 93975 |
|
4,250 |
4,186 |
$72K |
| 96113 |
|
988 |
988 |
$71K |
| 76700 |
|
7,491 |
7,367 |
$70K |
| J7620 |
Albuterol ipratrop non-comp |
506 |
445 |
$64K |
| G0108 |
Diab manage trn per indiv |
16,938 |
12,566 |
$63K |
| 73130 |
|
11,088 |
10,287 |
$59K |
| 73610 |
|
9,682 |
9,182 |
$59K |
| 71260 |
|
4,108 |
4,028 |
$58K |
| 71045 |
|
32,548 |
31,040 |
$58K |
| 43239 |
|
3,671 |
3,628 |
$56K |
| G0463 |
Hospital outpt clinic visit |
3,528 |
2,792 |
$56K |
| J7613 |
Albuterol non-comp unit |
2,502 |
2,294 |
$55K |
| 70551 |
|
2,370 |
2,285 |
$55K |
| 80048 |
|
30,951 |
24,991 |
$54K |
| 96365 |
|
7,207 |
5,130 |
$53K |
| 87653 |
|
11,047 |
10,680 |
$50K |
| 99285 |
|
1,151 |
1,012 |
$50K |
| 80053 |
|
54,181 |
49,676 |
$50K |
| 84702 |
|
33,258 |
28,950 |
$49K |
| 96413 |
|
5,768 |
3,766 |
$48K |
| 86696 |
|
12,660 |
12,429 |
$48K |
| 72148 |
|
1,363 |
1,340 |
$48K |
| 86900 |
|
27,366 |
26,237 |
$46K |
| 86762 |
|
11,580 |
11,482 |
$45K |
| 0250 |
|
6,239 |
4,522 |
$45K |
| 95886 |
|
5,963 |
4,326 |
$45K |
| 80076 |
|
68,559 |
63,182 |
$44K |
| 84443 |
|
38,266 |
37,121 |
$44K |
| 96367 |
|
4,054 |
2,377 |
$43K |
| 84484 |
|
51,527 |
43,707 |
$43K |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
21,990 |
21,069 |
$43K |
| 0636 |
|
1,171 |
1,046 |
$43K |
| 73630 |
|
10,793 |
10,256 |
$43K |
| 95816 |
|
4,650 |
3,759 |
$42K |
| Q0144 |
Azithromycin dihydrate, oral |
570 |
516 |
$42K |
| 87340 |
|
15,694 |
15,156 |
$42K |
| 73564 |
|
9,329 |
8,886 |
$39K |
| 96111 |
|
339 |
339 |
$37K |
| J2704 |
Inj, propofol, 10 mg |
14,286 |
10,867 |
$37K |
| 76825 |
|
1,327 |
1,322 |
$36K |
| 73110 |
|
6,850 |
6,367 |
$35K |
| 80307 |
|
8,549 |
8,081 |
$35K |
| 76827 |
|
1,219 |
1,215 |
$34K |
| 99281 |
|
1,059 |
907 |
$33K |
| 71250 |
|
783 |
756 |
$32K |
| 94729 |
|
6,516 |
5,081 |
$32K |
| 94060 |
|
6,546 |
5,216 |
$32K |
| 73030 |
|
7,579 |
7,275 |
$31K |
| 78452 |
|
853 |
783 |
$31K |
| 36415 |
|
9,462 |
7,735 |
$30K |
| 86480 |
|
1,970 |
1,940 |
$29K |
| J9355 |
Inj trastuzumab excl biosimi |
243 |
108 |
$29K |
| 96375 |
|
23,126 |
20,013 |
$29K |
| 92507 |
|
4,065 |
1,974 |
$28K |
| U0003 |
Cov-19 amp prb hgh thruput |
1,745 |
1,727 |
$27K |
| A9500 |
Tc99m sestamibi |
923 |
853 |
$26K |
| 0324 |
|
777 |
741 |
$26K |
| Z4302 |
|
2,098 |
2,098 |
$25K |
| 72141 |
|
628 |
599 |
$25K |
| J2357 |
Omalizumab injection |
1,169 |
698 |
$25K |
| 71275 |
|
3,947 |
3,786 |
$25K |
| J9310 |
Rituximab injection |
61 |
32 |
$24K |
| 76815 |
|
1,918 |
1,563 |
$24K |
| 87502 |
|
8,759 |
8,418 |
$24K |
| 59025 |
|
2,073 |
760 |
$23K |
| 86481 |
|
7,281 |
7,240 |
$22K |
| 76830 |
|
7,165 |
7,094 |
$22K |
| J1453 |
Fosaprepitant injection |
515 |
352 |
$22K |
| 83690 |
|
51,459 |
47,423 |
$22K |
| 96415 |
|
2,585 |
1,998 |
$21K |
| 87088 |
|
20,193 |
19,339 |
$20K |
| 87536 |
|
6,800 |
6,725 |
$20K |
| 82962 |
|
18,960 |
14,519 |
$19K |
| S9460 |
Diabetic management program, |
343 |
262 |
$19K |
| 86901 |
|
27,367 |
26,234 |
$19K |
| 96360 |
|
2,475 |
2,236 |
$19K |
| 85610 |
|
30,140 |
27,149 |
$18K |
| 82306 |
|
12,309 |
12,198 |
$17K |
| G0480 |
Drug test def 1-7 classes |
8,398 |
7,966 |
$17K |
| 76770 |
|
2,755 |
2,672 |
$17K |
| 85027 |
|
18,731 |
16,834 |
$17K |
| 96366 |
|
3,418 |
2,254 |
$17K |
| 97165 |
|
2,236 |
1,991 |
$17K |
| 74176 |
|
2,618 |
2,545 |
$16K |
| J1745 |
Infliximab not biosimil 10mg |
28 |
25 |
$16K |
| 83880 |
|
15,959 |
14,089 |
$16K |
| 72125 |
|
3,051 |
2,987 |
$16K |
| 99284 |
|
1,567 |
1,460 |
$16K |
| 94726 |
|
4,315 |
3,237 |
$15K |
| 73502 |
|
3,334 |
3,221 |
$15K |
| 74170 |
|
782 |
742 |
$15K |
| 80061 |
|
28,797 |
28,295 |
$14K |
| 87632 |
|
3,153 |
3,086 |
$14K |
| 96361 |
|
3,593 |
2,714 |
$14K |
| 93971 |
|
3,029 |
2,930 |
$14K |
| 95885 |
|
1,204 |
1,099 |
$14K |
| 93970 |
|
914 |
887 |
$14K |
| 70486 |
|
2,116 |
2,079 |
$14K |
| 73080 |
|
3,694 |
3,554 |
$14K |
| 86592 |
|
7,452 |
7,206 |
$14K |
| J3010 |
Fentanyl citrate injection |
22,029 |
19,341 |
$14K |
| J7120 |
Ringers lactate infusion |
17,910 |
16,514 |
$14K |
| 86695 |
|
4,421 |
4,371 |
$14K |
| 72126 |
|
1,911 |
1,878 |
$13K |
| 73590 |
|
5,046 |
4,787 |
$13K |
| 81220 |
|
2,873 |
2,843 |
$13K |
| 72100 |
|
4,074 |
4,003 |
$12K |
| 96417 |
|
1,070 |
665 |
$12K |
| Z4308 |
|
477 |
455 |
$12K |
| 86361 |
|
6,533 |
6,458 |
$12K |
| 76705 |
|
6,066 |
5,912 |
$12K |
| 0750 |
|
44 |
43 |
$12K |
| J7050 |
Normal saline solution infus |
11,661 |
6,474 |
$11K |
| 91200 |
|
2,294 |
2,291 |
$11K |
| Z7506 |
|
124 |
70 |
$11K |
| J0690 |
Cefazolin sodium injection |
2,700 |
2,400 |
$11K |
| 0300 |
|
1,044 |
959 |
$11K |
| 70491 |
|
714 |
703 |
$11K |
| 16020 |
|
1,293 |
990 |
$11K |
| 87210 |
|
19,021 |
18,007 |
$11K |
| 76536 |
|
1,285 |
1,275 |
$11K |
| 0272 |
|
791 |
738 |
$11K |
| 93458 |
|
332 |
330 |
$11K |
| 73552 |
|
2,585 |
2,488 |
$11K |
| 73090 |
|
3,676 |
3,476 |
$10K |
| 83970 |
|
2,580 |
2,533 |
$10K |
| 76856 |
|
7,329 |
7,258 |
$10K |
| 94010 |
|
3,312 |
2,938 |
$10K |
| 93017 |
|
1,569 |
1,488 |
$10K |
| 72110 |
|
1,541 |
1,531 |
$10K |
| J2405 |
Ondansetron hcl injection |
21,062 |
17,457 |
$9K |
| J2785 |
Regadenoson injection |
592 |
528 |
$9K |
| 93880 |
|
411 |
370 |
$9K |
| 83735 |
|
17,976 |
13,409 |
$9K |
| 76811 |
|
736 |
720 |
$9K |
| Z4301 |
|
267 |
245 |
$9K |
| J1200 |
Diphenhydramine hcl injectio |
9,350 |
7,977 |
$9K |
| Z4307 |
|
329 |
322 |
$9K |
| 90715 |
|
6,800 |
6,723 |
$9K |
| 72050 |
|
1,772 |
1,757 |
$8K |
| 36821 |
|
233 |
230 |
$8K |
| 74018 |
|
3,267 |
3,171 |
$8K |
| 77334 |
|
125 |
105 |
$8K |
| 97166 |
|
236 |
222 |
$8K |
| 82950 |
|
8,701 |
8,655 |
$8K |
| 94727 |
|
942 |
772 |
$8K |
| J2778 |
Ranibizumab injection |
38 |
37 |
$8K |
| G0109 |
Diab manage trn ind/group |
1,777 |
1,348 |
$8K |
| J1100 |
Dexamethasone sodium phos |
7,598 |
6,036 |
$8K |
| 90686 |
|
1,410 |
1,368 |
$8K |
| 76642 |
|
535 |
479 |
$8K |
| 90734 |
|
277 |
277 |
$7K |
| 94640 |
|
5,168 |
4,329 |
$7K |
| 82247 |
|
6,025 |
5,070 |
$7K |
| 71020 |
|
1,755 |
925 |
$7K |
| 97010 |
|
9,682 |
3,700 |
$7K |
| J2250 |
Inj midazolam hydrochloride |
8,075 |
7,513 |
$7K |
| J9070 |
Cyclophosphamide 100 mg inj |
123 |
37 |
$7K |
| J7307 |
Etonogestrel implant system |
81 |
80 |
$7K |
| 87811 |
|
3,589 |
3,502 |
$7K |
| 94760 |
|
2,679 |
2,537 |
$7K |
| 99213 |
|
866 |
777 |
$7K |
| J1439 |
Inj ferric carboxymaltos 1mg |
399 |
301 |
$7K |
| 86593 |
|
3,545 |
3,397 |
$7K |
| 87503 |
|
8,755 |
8,414 |
$7K |
| 80074 |
|
2,705 |
2,639 |
$7K |
| 87506 |
|
1,142 |
1,111 |
$6K |
| 84703 |
|
17,423 |
16,725 |
$6K |
| 77066 |
Tomosynthesis, mammo |
186 |
185 |
$6K |
| 77336 |
|
374 |
168 |
$6K |
| 70544 |
|
250 |
215 |
$6K |
| 0352 |
|
44 |
42 |
$6K |
| J0178 |
Aflibercept injection |
20 |
20 |
$6K |
| 76801 |
|
4,317 |
4,003 |
$6K |
| 97803 |
|
2,775 |
2,671 |
$6K |
| 86803 |
|
8,847 |
8,750 |
$6K |
| 90471 |
|
11,108 |
10,765 |
$6K |
| 83615 |
|
6,499 |
5,493 |
$6K |
| 94618 |
|
1,899 |
1,379 |
$6K |
| 72170 |
|
2,972 |
2,899 |
$6K |
| J7611 |
Albuterol non-comp con |
3,187 |
2,677 |
$6K |
| 82728 |
|
7,311 |
7,141 |
$6K |
| 77063 |
|
2,353 |
2,350 |
$6K |
| 85730 |
|
8,634 |
8,263 |
$6K |
| 36832 |
|
203 |
193 |
$6K |
| 0403 |
|
94 |
94 |
$6K |
| 73060 |
|
2,048 |
1,950 |
$6K |
| 86003 |
|
430 |
420 |
$6K |
| 84436 |
|
3,687 |
3,628 |
$5K |
| 0301 |
|
309 |
276 |
$5K |
| J1642 |
Inj heparin sodium per 10 u |
4,507 |
2,574 |
$5K |
| 77065 |
Tomosynthesis, mammo |
227 |
222 |
$5K |
| 77412 |
|
771 |
88 |
$5K |
| 73600 |
|
123 |
114 |
$5K |
| P9016 |
Rbc leukocytes reduced |
383 |
345 |
$5K |
| J0897 |
Denosumab injection |
55 |
54 |
$5K |
| 87081 |
|
3,275 |
3,240 |
$5K |
| Z4311 |
|
429 |
422 |
$5K |
| 72131 |
|
956 |
928 |
$5K |
| 73140 |
|
726 |
695 |
$5K |
| 70496 |
|
834 |
767 |
$5K |
| 82746 |
|
4,827 |
4,736 |
$5K |
| 84466 |
|
7,979 |
7,804 |
$5K |
| J0131 |
Inj, acetaminophen (nos) |
508 |
475 |
$5K |
| J7040 |
Normal saline solution infus |
5,283 |
4,212 |
$5K |
| 67028 |
|
180 |
161 |
$5K |
| 70498 |
|
877 |
851 |
$5K |
| 83655 |
|
5,658 |
5,625 |
$5K |
| A9579 |
Gad-base mr contrast nos,1ml |
1,331 |
1,265 |
$5K |
| Q9957 |
Inj perflutren lip micros,ml |
557 |
511 |
$5K |
| 90649 |
|
71 |
70 |
$5K |
| 76870 |
|
1,300 |
1,265 |
$5K |
| 0762 |
|
1,173 |
526 |
$5K |
| 96416 |
|
320 |
184 |
$4K |
| J0885 |
Epoetin alfa, non-esrd |
124 |
78 |
$4K |
| 73562 |
|
1,374 |
1,242 |
$4K |
| 82607 |
|
8,409 |
8,259 |
$4K |
| 96411 |
|
472 |
294 |
$4K |
| 82140 |
|
2,762 |
2,516 |
$4K |
| 72072 |
|
690 |
685 |
$4K |
| T1014 |
Telehealth transmit, per min |
3,842 |
3,039 |
$4K |
| Z4312 |
|
323 |
313 |
$4K |
| 87077 |
|
6,687 |
6,477 |
$4K |
| 76817 |
|
2,084 |
1,968 |
$4K |
| 91037 |
|
347 |
347 |
$4K |
| 87522 |
Neg quan hep c or qual rna |
1,457 |
1,427 |
$4K |
| 70355 |
|
777 |
760 |
$4K |
| 86140 |
|
9,621 |
9,173 |
$4K |
| J1569 |
Gammagard liquid injection |
71 |
25 |
$4K |
| 82274 |
|
4,140 |
4,076 |
$4K |
| 88342 |
|
559 |
556 |
$4K |
| 93308 |
|
386 |
350 |
$4K |
| 87186 |
|
5,924 |
5,704 |
$3K |
| 72040 |
|
575 |
568 |
$3K |
| J2001 |
Lidocaine injection |
6,682 |
6,105 |
$3K |
| 84100 |
|
12,703 |
9,903 |
$3K |
| 82570 |
|
12,393 |
11,692 |
$3K |
| 93990 |
|
53 |
53 |
$3K |
| 72190 |
|
303 |
300 |
$3K |
| Q4081 |
Epoetin alfa, 100 units esrd |
1,499 |
199 |
$3K |
| 94664 |
|
3,577 |
3,246 |
$3K |
| 94644 |
|
2,788 |
2,466 |
$3K |
| 74240 |
|
356 |
356 |
$3K |
| 0320 |
|
479 |
443 |
$3K |
| 90732 |
|
124 |
121 |
$3K |
| 84550 |
|
6,376 |
5,643 |
$3K |
| 97112 |
|
1,459 |
569 |
$3K |
| 83605 |
|
9,229 |
8,492 |
$3K |
| 70487 |
|
132 |
128 |
$3K |
| 99152 |
|
537 |
512 |
$3K |
| S9470 |
Nutritional counseling, diet |
44 |
42 |
$3K |
| 84439 |
|
8,306 |
8,007 |
$3K |
| 82565 |
|
5,533 |
5,116 |
$3K |
| 86923 |
|
1,114 |
982 |
$3K |
| J1644 |
Inj heparin sodium per 1000u |
10,128 |
3,703 |
$3K |
| J9312 |
Inj., rituximab, 10 mg |
30 |
12 |
$3K |
| 83540 |
|
8,276 |
8,099 |
$3K |
| Q0138 |
Ferumoxytol, non-esrd |
219 |
146 |
$3K |
| 45378 |
|
305 |
299 |
$3K |
| 87040 |
|
3,115 |
2,850 |
$3K |
| J2560 |
Phenobarbital sodium inj |
2,062 |
1,740 |
$3K |
| 87430 |
|
3,236 |
3,202 |
$3K |
| 86235 |
|
1,248 |
937 |
$3K |
| 87798 |
|
1,040 |
987 |
$3K |
| J7060 |
5% dextrose/water |
1,975 |
803 |
$3K |
| 96368 |
|
364 |
205 |
$3K |
| 82731 |
|
813 |
772 |
$3K |
| 73721 |
|
85 |
81 |
$3K |
| 84460 |
|
4,265 |
3,940 |
$2K |
| 91010 |
|
347 |
347 |
$2K |
| 77290 |
|
77 |
65 |
$2K |
| J1885 |
Ketorolac tromethamine inj |
9,958 |
9,233 |
$2K |
| J1050 |
Medroxyprogesterone acetate |
297 |
297 |
$2K |
| 97140 |
|
613 |
294 |
$2K |
| 82533 |
|
2,337 |
2,260 |
$2K |
| 90746 |
|
113 |
113 |
$2K |
| 70360 |
|
507 |
498 |
$2K |
| S9455 |
Diabetic management program, |
73 |
57 |
$2K |
| 73700 |
|
286 |
276 |
$2K |
| 97162 |
|
1,343 |
1,278 |
$2K |
| J2270 |
Morphine sulfate injection |
10,825 |
8,623 |
$2K |
| 82784 |
|
1,239 |
1,173 |
$2K |
| 84450 |
|
4,083 |
3,781 |
$2K |
| J9267 |
Paclitaxel injection |
268 |
121 |
$2K |
| 87070 |
|
2,241 |
2,095 |
$2K |
| A9575 |
Inj gadoterate meglumi 0.1ml |
884 |
862 |
$2K |
| 0370 |
|
651 |
644 |
$2K |
| 0410 |
|
53 |
48 |
$2K |
| 84156 |
|
7,770 |
6,430 |
$2K |
| 94728 |
|
622 |
610 |
$2K |
| 92523 |
|
67 |
67 |
$2K |
| 85379 |
|
5,929 |
5,724 |
$2K |
| 82951 |
|
2,594 |
2,580 |
$2K |
| 80069 |
|
1,909 |
1,722 |
$2K |
| 72070 |
|
687 |
669 |
$2K |
| 82550 |
|
3,326 |
3,129 |
$2K |
| 82105 |
|
1,640 |
1,615 |
$2K |
| 0430 |
|
28 |
16 |
$2K |
| 80051 |
|
735 |
719 |
$2K |
| 82670 |
|
1,655 |
1,642 |
$2K |
| J1756 |
Iron sucrose injection |
1,241 |
436 |
$2K |
| 95909 |
|
205 |
142 |
$2K |
| 0401 |
|
16 |
16 |
$2K |
| J3475 |
Inj magnesium sulfate |
1,970 |
1,344 |
$2K |
| 90677 |
|
106 |
106 |
$1K |
| 89060 |
|
2,299 |
2,161 |
$1K |
| 81003 |
|
1,328 |
1,031 |
$1K |
| 92521 |
|
438 |
436 |
$1K |
| 96523 |
|
136 |
117 |
$1K |
| 86038 |
|
2,556 |
2,499 |
$1K |
| 85651 |
|
9,486 |
9,057 |
$1K |
| 99221 |
|
144 |
126 |
$1K |
| 45380 |
|
231 |
230 |
$1K |
| 45385 |
|
203 |
202 |
$1K |
| 82803 |
|
770 |
699 |
$1K |
| J9045 |
Carboplatin injection |
153 |
119 |
$1K |
| 84153 |
|
650 |
635 |
$1K |
| J1170 |
Hydromorphone injection |
2,263 |
1,805 |
$1K |
| 84403 |
|
1,942 |
1,922 |
$1K |
| J2765 |
Metoclopramide hcl injection |
3,793 |
3,400 |
$1K |
| 84481 |
|
2,328 |
2,304 |
$1K |
| 95913 |
|
15 |
14 |
$1K |
| Z4310 |
|
106 |
103 |
$1K |
| 85018 |
|
420 |
376 |
$1K |
| 77300 |
|
72 |
67 |
$1K |
| 72114 |
|
318 |
316 |
$1K |
| 99214 |
|
471 |
453 |
$1K |
| J0640 |
Leucovorin calcium injection |
235 |
128 |
$1K |
| G0279 |
Tomosynthesis, mammo |
243 |
243 |
$1K |
| J0696 |
Ceftriaxone sodium injection |
6,839 |
5,983 |
$1K |
| 86706 |
|
3,527 |
3,510 |
$1K |
| 87075 |
|
1,295 |
1,189 |
$1K |
| 72128 |
|
351 |
349 |
$1K |
| 84402 |
|
1,461 |
1,447 |
$1K |
| J0780 |
Prochlorperazine injection |
4,859 |
4,657 |
$1K |
| 90670 |
|
65 |
63 |
$1K |
| 84146 |
|
2,418 |
2,391 |
$1K |
| J0561 |
Penicillin g benzathine inj |
738 |
635 |
$1K |
| J1815 |
Insulin injection |
8,650 |
4,126 |
$1K |
| 82248 |
|
2,803 |
2,401 |
$1K |
| J9190 |
Fluorouracil injection |
419 |
167 |
$1K |
| 86635 |
|
656 |
630 |
$1K |
| 93000 |
|
72 |
68 |
$1K |
| 82785 |
|
681 |
674 |
$1K |
| 93041 |
|
248 |
243 |
$1K |
| 82043 |
|
6,432 |
6,394 |
$1K |
| 86704 |
|
2,363 |
2,356 |
$1K |
| 96521 |
|
200 |
119 |
$1K |
| 86331 |
|
1,092 |
1,077 |
$1K |
| 86171 |
|
1,085 |
1,069 |
$1K |
| 85384 |
|
748 |
680 |
$998.40 |
| 49083 |
|
99 |
77 |
$987.90 |
| 0391 |
|
26 |
17 |
$977.57 |
| 93225 |
|
42 |
42 |
$975.15 |
| 87205 |
|
2,504 |
2,336 |
$969.07 |
| J2060 |
Lorazepam injection |
6,223 |
5,265 |
$956.64 |
| J7518 |
Mycophenolic acid |
14 |
14 |
$952.20 |
| 82378 |
|
259 |
238 |
$929.56 |
| J1650 |
Inj enoxaparin sodium |
4,951 |
2,265 |
$927.23 |
| J2780 |
Ranitidine hydrochloride inj |
636 |
372 |
$922.03 |
| 87177 |
|
182 |
161 |
$898.31 |
| 83516 |
|
1,370 |
1,305 |
$886.28 |
| 83883 |
|
168 |
150 |
$882.69 |
| 83001 |
|
2,347 |
2,332 |
$880.16 |
| Q9963 |
Hocm 350-399mg/ml iodine,1ml |
293 |
264 |
$864.21 |
| J3301 |
Triamcinolone acet inj nos |
421 |
410 |
$863.17 |
| 70547 |
|
74 |
69 |
$827.34 |
| 99211 |
|
44 |
41 |
$823.76 |
| 93976 |
|
25 |
25 |
$815.15 |
| 43249 |
|
107 |
107 |
$809.93 |
| S9465 |
Diabetic management program, |
13 |
12 |
$801.58 |
| 74221 |
|
29 |
29 |
$782.96 |
| 80185 |
|
285 |
237 |
$781.86 |
| 85045 |
|
1,811 |
1,579 |
$781.82 |
| 84425 |
|
916 |
907 |
$770.70 |
| 95912 |
|
20 |
12 |
$770.20 |
| 80164 |
|
248 |
210 |
$767.38 |
| 93226 |
|
16 |
16 |
$765.27 |
| 74178 |
|
42 |
42 |
$738.77 |
| 86225 |
|
1,272 |
1,241 |
$722.24 |
| Z5406 |
|
58 |
42 |
$710.95 |
| J2359 |
Inj. olanzapine, 0.5mg |
303 |
276 |
$690.61 |
| 86708 |
|
1,990 |
1,982 |
$685.26 |
| J9217 |
Leuprolide acetate suspnsion |
29 |
29 |
$682.53 |
| 99212 |
|
115 |
103 |
$678.56 |
| 87661 |
|
2,764 |
2,733 |
$671.72 |
| 86308 |
|
142 |
138 |
$664.86 |
| J7321 |
Hyalgan supartz visco-3 dose |
128 |
85 |
$655.97 |
| Z4303 |
|
14 |
14 |
$645.45 |
| 84207 |
|
281 |
278 |
$636.30 |
| 88720 |
|
228 |
175 |
$635.21 |
| 97161 |
|
1,143 |
636 |
$611.47 |
| 86160 |
|
398 |
383 |
$586.63 |
| 85460 |
|
233 |
218 |
$577.45 |
| 89051 |
|
450 |
380 |
$576.89 |
| 73560 |
|
274 |
256 |
$574.43 |
| J0129 |
Abatacept injection |
15 |
14 |
$565.37 |
| 20610 |
|
303 |
266 |
$564.29 |
| 90619 |
|
98 |
98 |
$563.28 |
| J9263 |
Oxaliplatin |
158 |
57 |
$553.21 |
| 82150 |
|
398 |
360 |
$552.06 |
| J0689 |
Inj cefazolin sodium, baxter |
524 |
504 |
$535.37 |
| 83002 |
|
1,532 |
1,521 |
$533.61 |
| Q0162 |
Ondansetron oral |
2,732 |
2,526 |
$524.71 |
| J3370 |
Vancomycin hcl injection |
1,050 |
677 |
$520.32 |
| 71010 |
|
258 |
96 |
$519.35 |
| 0730 |
|
435 |
407 |
$512.63 |
| 99282 |
|
16 |
16 |
$509.96 |
| J1630 |
Haloperidol injection |
4,733 |
4,114 |
$501.29 |
| 86039 |
|
537 |
518 |
$492.39 |
| 84165 |
|
416 |
385 |
$489.64 |
| 84145 |
|
504 |
499 |
$485.36 |
| 88341 |
|
37 |
36 |
$466.67 |
| 87338 |
|
1,608 |
1,599 |
$464.87 |
| 93321 |
|
168 |
147 |
$462.39 |
| J7517 |
Mycophenolate mofetil oral |
20 |
20 |
$461.78 |
| 82952 |
|
2,263 |
2,259 |
$459.99 |
| 84520 |
|
1,574 |
1,388 |
$435.68 |
| 86430 |
|
1,367 |
1,338 |
$426.02 |
| 97163 |
|
61 |
61 |
$418.50 |
| J7507 |
Tacrolimus imme rel oral 1mg |
45 |
41 |
$414.52 |
| 87480 |
|
188 |
185 |
$413.64 |
| 87510 |
|
188 |
185 |
$413.64 |
| J1750 |
Inj iron dextran |
88 |
60 |
$413.19 |
| S0020 |
Injection, bupivicaine hydro |
664 |
653 |
$409.23 |
| 74220 |
|
87 |
87 |
$408.70 |
| 0489 |
|
39 |
38 |
$406.26 |
| 81050 |
|
1,618 |
1,585 |
$390.96 |
| 94002 |
|
62 |
28 |
$388.08 |
| 84155 |
|
948 |
879 |
$386.48 |
| 92522 |
|
14 |
14 |
$385.45 |
| 72081 |
|
232 |
232 |
$371.42 |
| 86141 |
|
190 |
176 |
$364.86 |
| J3420 |
Vitamin b12 injection |
280 |
232 |
$363.05 |
| J1270 |
Injection, doxercalciferol |
740 |
88 |
$357.26 |
| 95718 |
|
37 |
37 |
$355.26 |
| 94645 |
|
263 |
224 |
$352.81 |
| A9502 |
Tc99m tetrofosmin |
14 |
14 |
$351.64 |
| 87660 |
|
188 |
185 |
$349.19 |
| 88304 |
|
35 |
35 |
$348.05 |
| 96376 |
|
1,993 |
1,456 |
$346.13 |
| 76942 |
|
80 |
74 |
$340.19 |
| 42820 |
|
13 |
13 |
$340.00 |
| 82270 |
|
1,165 |
1,151 |
$339.59 |
| 78815 |
|
29 |
29 |
$334.35 |
| Q0513 |
Disp fee inhal drugs/30 days |
65 |
65 |
$332.50 |
| 74000 |
|
69 |
34 |
$326.55 |
| 82977 |
|
295 |
288 |
$317.74 |
| 87493 |
|
320 |
314 |
$308.99 |
| 82947 |
|
787 |
771 |
$306.61 |
| 86376 |
|
525 |
522 |
$285.20 |
| Q0163 |
Diphenhydramine hcl 50mg |
539 |
473 |
$282.78 |
| 93015 |
|
26 |
26 |
$279.86 |
| 94620 |
|
35 |
15 |
$279.77 |
| 97802 |
|
55 |
54 |
$276.59 |
| 83520 |
|
570 |
547 |
$274.68 |
| 82240 |
|
83 |
82 |
$274.35 |
| 20611 |
|
139 |
104 |
$270.50 |
| J2370 |
Phenylephrine hcl injection |
36 |
30 |
$267.84 |
| J7512 |
Prednisone ir or dr oral 1mg |
706 |
555 |
$267.67 |
| 99231 |
|
182 |
155 |
$261.71 |
| 77002 |
|
27 |
17 |
$259.89 |
| 99070 |
|
411 |
182 |
$253.73 |
| 86334 |
|
27 |
24 |
$252.00 |
| J2930 |
Methylprednisolone injection |
570 |
376 |
$247.12 |
| 73000 |
|
42 |
39 |
$243.65 |
| J7626 |
Budesonide non-comp unit |
18 |
12 |
$242.70 |
| 71101 |
|
209 |
207 |
$240.98 |
| 86147 |
|
65 |
61 |
$236.25 |
| 84134 |
|
47 |
43 |
$233.70 |
| 86200 |
|
424 |
421 |
$226.30 |
| J2469 |
Palonosetron hcl |
17 |
16 |
$224.96 |
| 0361 |
|
16 |
15 |
$222.18 |
| 86800 |
|
245 |
244 |
$222.08 |
| 20553 |
|
77 |
72 |
$205.31 |
| 76641 |
|
27 |
14 |
$201.92 |
| J1030 |
Methylprednisolone 40 mg inj |
183 |
179 |
$199.57 |
| 0306 |
|
50 |
46 |
$196.70 |
| J0171 |
Adrenalin epinephrine inject |
382 |
349 |
$196.65 |
| Q0511 |
Sup fee antiem,antica,immuno |
47 |
47 |
$192.00 |
| J3489 |
Zoledronic acid 1mg |
46 |
42 |
$185.14 |
| J0702 |
Betamethasone acet&sod phosp |
74 |
58 |
$184.60 |
| 99153 |
Mod sedat endo service >5yrs |
84 |
79 |
$184.25 |
| 87581 |
|
73 |
41 |
$183.01 |
| 87086 |
|
92 |
92 |
$180.93 |
| J2175 |
Meperidine hydrochl /100 mg |
32 |
27 |
$176.26 |
| J1940 |
Furosemide injection |
1,024 |
658 |
$173.34 |
| J9000 |
Doxorubicin hcl injection |
20 |
13 |
$168.97 |
| 90656 |
|
113 |
113 |
$168.44 |
| 97530 |
|
568 |
266 |
$166.91 |
| 84132 |
|
450 |
404 |
$160.83 |
| G0365 |
Vessel mapping hemo access |
231 |
213 |
$160.32 |
| 76881 |
|
12 |
12 |
$148.83 |
| G0008 |
Admin influenza virus vac |
13 |
12 |
$145.50 |
| 96402 |
|
29 |
28 |
$144.54 |
| Q0512 |
Px sup fee anti-can sub pres |
51 |
45 |
$137.60 |
| J1040 |
Methylprednisolone 80 mg inj |
73 |
71 |
$135.30 |
| J0665 |
Inj, bupivacaine, nos, 0.5mg |
288 |
284 |
$127.54 |
| 86304 |
|
12 |
12 |
$115.24 |
| 95910 |
|
22 |
15 |
$110.09 |
| 20552 |
|
19 |
19 |
$109.72 |
| 43235 |
|
13 |
12 |
$106.40 |
| 87209 |
|
82 |
69 |
$106.37 |
| J0295 |
Ampicillin sulbactam 1.5 gm |
388 |
314 |
$106.10 |
| 70220 |
|
14 |
14 |
$105.76 |
| 77280 |
|
31 |
29 |
$104.83 |
| 73100 |
|
48 |
40 |
$99.62 |
| 92134 |
|
131 |
124 |
$98.70 |
| 82810 |
|
29 |
29 |
$97.20 |
| 84480 |
|
70 |
67 |
$97.09 |
| 83010 |
|
44 |
39 |
$95.52 |
| 95819 |
|
14 |
12 |
$93.25 |
| 73070 |
|
32 |
30 |
$87.00 |
| J1071 |
Inj testosterone cypionate |
91 |
62 |
$85.40 |
| 86255 |
|
562 |
544 |
$81.58 |
| 80177 |
|
70 |
67 |
$81.57 |
| 92012 |
|
14 |
14 |
$74.30 |
| J0137 |
Inj, acetaminophen (hikma) |
27 |
27 |
$66.53 |
| 84300 |
|
116 |
109 |
$66.18 |
| 86146 |
|
13 |
12 |
$66.00 |
| 99204 |
|
25 |
25 |
$62.01 |
| 95012 |
|
17 |
15 |
$59.40 |
| 73521 |
|
26 |
25 |
$57.56 |
| 99215 |
Prolong outpt/office vis |
19 |
19 |
$57.20 |
| 99203 |
|
12 |
12 |
$57.20 |
| A9552 |
F18 fdg |
30 |
30 |
$56.59 |
| 90714 |
|
268 |
268 |
$55.19 |
| J0153 |
Adenosine inj 1mg |
19 |
17 |
$50.78 |
| 82310 |
|
73 |
59 |
$48.23 |
| 0420 |
|
191 |
177 |
$46.74 |
| J0360 |
Hydralazine hcl injection |
218 |
142 |
$46.68 |
| 85613 |
|
37 |
37 |
$45.87 |
| 43450 |
|
15 |
15 |
$45.60 |
| J2003 |
Inj, lidocaine hcl, 1 mg |
217 |
209 |
$43.46 |
| 20605 |
|
16 |
16 |
$43.26 |
| 87449 |
|
12 |
12 |
$43.02 |
| 92014 |
|
48 |
40 |
$38.43 |
| Q3014 |
Telehealth facility fee |
18 |
17 |
$37.00 |
| 90472 |
|
59 |
59 |
$36.80 |
| J1953 |
Levetiracetam injection |
401 |
357 |
$36.58 |
| A4657 |
Syringe w/wo needle |
346 |
72 |
$34.44 |
| 80306 |
|
12 |
12 |
$33.04 |
| 82652 |
|
107 |
105 |
$30.00 |
| 0255 |
|
62 |
60 |
$29.20 |
| 84075 |
|
41 |
40 |
$28.58 |
| J2919 |
Inj, methylpred sod succ 5mg |
144 |
124 |
$28.50 |
| 96409 |
|
22 |
15 |
$27.30 |
| 20550 |
|
40 |
35 |
$24.40 |
| 84432 |
|
25 |
25 |
$21.82 |
| 0258 |
|
325 |
314 |
$20.28 |
| J7644 |
Ipratropium bromide non-comp |
15 |
15 |
$19.53 |
| 82436 |
|
12 |
12 |
$18.76 |
| 82010 |
|
155 |
151 |
$15.68 |
| J1580 |
Garamycin gentamicin inj |
42 |
40 |
$13.90 |
| 85014 |
|
283 |
275 |
$11.80 |
| 83921 |
|
142 |
141 |
$11.62 |
| 99000 |
|
149 |
135 |
$10.42 |
| 83930 |
|
12 |
12 |
$9.24 |
| 77332 |
|
14 |
12 |
$8.54 |
| J2004 |
Inj, lidocaine w epinephrine |
73 |
73 |
$6.67 |
| J7042 |
5% dextrose/normal saline |
109 |
65 |
$6.48 |
| J2470 |
Inj pantoprazole sodium 40mg |
14 |
12 |
$6.39 |
| 86880 |
|
14 |
14 |
$5.17 |
| J7999 |
Compounded drug, noc |
13 |
13 |
$4.96 |
| 81002 |
|
46 |
46 |
$4.30 |
| 90744 |
|
1,124 |
1,089 |
$2.22 |
| A4649 |
Surgical supplies |
672 |
238 |
$2.09 |
| J1171 |
Inj, hydromorphone, 0.1 mg |
26 |
20 |
$0.54 |
| 77417 |
|
60 |
31 |
$0.00 |
| 36416 |
|
121 |
102 |
$0.00 |
| 0250R |
|
472 |
411 |
$0.00 |
| 81000 |
|
146 |
146 |
$0.00 |
| 1036F |
|
59 |
50 |
$0.00 |
| 97535 |
|
127 |
107 |
$0.00 |
| J8540 |
Oral dexamethasone |
85 |
82 |
$0.00 |
| H2019 |
Ther behav svc, per 15 min |
2,742 |
275 |
$0.00 |
| 3008F |
|
33 |
33 |
$0.00 |
| 82330 |
|
25 |
24 |
$0.00 |
| 64484 |
|
15 |
13 |
$0.00 |
| 92250 |
|
25 |
25 |
$0.00 |
| 72158 |
|
13 |
12 |
$0.00 |
| H0049 |
Alcohol/drug screening |
35 |
35 |
$0.00 |
| 99366 |
|
16 |
13 |
$0.00 |
| 92551 |
|
163 |
163 |
$0.00 |
| 64483 |
|
33 |
33 |
$0.00 |
| 86870 |
|
12 |
12 |
$0.00 |
| A9270 |
Non-covered item or service |
49 |
13 |
$0.00 |
| 90647 |
|
12 |
12 |
$0.00 |
| 72146 |
|
12 |
12 |
$0.00 |
| 82040 |
|
16 |
16 |
$0.00 |
| 87635 |
|
20 |
20 |
$0.00 |
| G0010 |
Admin hepatitis b vaccine |
66 |
62 |
$0.00 |
| 96549 |
|
42 |
29 |
$0.00 |
| 0370R |
|
195 |
193 |
$0.00 |
| 86618 |
|
13 |
12 |
$0.00 |
| G9744 |
Pt not eli d/t act dig htn |
17 |
13 |
$0.00 |
| S5111 |
Family homecare train/sessio |
1,311 |
237 |
$0.00 |
| S0164 |
Injection pantroprazole |
14 |
12 |
$0.00 |
| 87902 |
|
539 |
536 |
$0.00 |
| J2310 |
Inj naloxone hydrochloride |
12 |
12 |
$0.00 |
| H0046 |
Mental health service, nos |
1,669 |
279 |
$0.00 |
| 77295 |
|
33 |
32 |
$0.00 |
| G0270 |
Mnt subs tx for change dx |
50 |
50 |
$0.00 |
| 0272R |
|
330 |
325 |
$0.00 |
| 90700 |
|
12 |
12 |
$0.00 |
| 76999 |
|
64 |
64 |
$0.00 |
| 92081 |
|
154 |
154 |
$0.00 |
| 0637 |
|
38 |
21 |
$0.00 |
| 0710R |
|
30 |
30 |
$0.00 |
| G8979 |
Mobility goal status |
44 |
38 |
$0.00 |
| G1004 |
Cdsm ndsc |
97 |
94 |
$0.00 |
| G8427 |
Docrev cur meds by elig clin |
81 |
73 |
$0.00 |
| 0681 |
|
25 |
25 |
$0.00 |
| 87901 |
|
18 |
18 |
$0.00 |
| 99392 |
|
14 |
14 |
$0.00 |
| 4040F |
|
23 |
16 |
$0.00 |
| 95713 |
|
12 |
12 |
$0.00 |
| 97116 |
|
30 |
12 |
$0.00 |
| G8978 |
Mobility current status |
24 |
24 |
$0.00 |
| 0302 |
|
25 |
24 |
$0.00 |
| 90460 |
|
67 |
67 |
$0.00 |
| G9500 |
Rad expos ind/exp tm doc |
18 |
12 |
$0.00 |
| 96160 |
|
36 |
36 |
$0.00 |
| 84630 |
|
25 |
25 |
$0.00 |
| 99391 |
|
12 |
12 |
$0.00 |