| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99284 |
|
1,579 |
1,350 |
$137K |
| 99204 |
|
486 |
486 |
$68K |
| 87633 |
|
179 |
176 |
$61K |
| 99285 |
|
505 |
425 |
$53K |
| 99214 |
|
410 |
407 |
$42K |
| 99283 |
|
976 |
831 |
$33K |
| 99215 |
Prolong outpt/office vis |
166 |
163 |
$24K |
| 43239 |
|
130 |
130 |
$22K |
| 74177 |
|
159 |
151 |
$16K |
| 80053 |
|
3,363 |
2,625 |
$9K |
| 99205 |
Prolong outpt/office vis |
37 |
37 |
$7K |
| 85025 |
|
2,859 |
2,270 |
$5K |
| 70450 |
|
132 |
128 |
$5K |
| 87798 |
|
172 |
168 |
$5K |
| 87486 |
|
157 |
154 |
$4K |
| 87581 |
|
157 |
154 |
$4K |
| 71046 |
|
247 |
238 |
$3K |
| 99222 |
|
27 |
27 |
$3K |
| 86140 |
|
2,122 |
1,773 |
$3K |
| 82805 |
|
256 |
221 |
$3K |
| 86710 |
|
94 |
90 |
$3K |
| 96361 |
|
878 |
700 |
$2K |
| 87086 |
|
550 |
494 |
$2K |
| 81001 |
|
1,880 |
1,640 |
$2K |
| 84484 |
|
736 |
629 |
$2K |
| 71045 |
|
1,066 |
922 |
$2K |
| 74176 |
|
25 |
24 |
$2K |
| 83690 |
|
448 |
406 |
$1K |
| 99232 |
|
20 |
12 |
$1K |
| 81025 |
|
198 |
190 |
$1K |
| J2274 |
Inj morphine pf epid ithc |
155 |
135 |
$1K |
| 96374 |
|
1,350 |
1,115 |
$1K |
| J3486 |
Ziprasidone mesylate |
32 |
28 |
$1K |
| 99238 |
|
18 |
18 |
$1K |
| 85027 |
|
389 |
333 |
$1K |
| 93010 |
|
176 |
173 |
$1K |
| 93000 |
|
99 |
96 |
$1K |
| 87430 |
|
61 |
60 |
$812.61 |
| 80305 |
|
78 |
70 |
$752.30 |
| 85378 |
|
113 |
110 |
$602.42 |
| 85007 |
|
344 |
307 |
$598.24 |
| 87040 |
|
27 |
27 |
$421.22 |
| 83735 |
|
260 |
228 |
$416.33 |
| 83880 |
|
13 |
13 |
$377.10 |
| 82948 |
|
65 |
41 |
$370.72 |
| J1885 |
Ketorolac tromethamine inj |
610 |
507 |
$370.12 |
| J2360 |
Orphenadrine injection |
80 |
79 |
$367.35 |
| 87081 |
|
55 |
54 |
$358.48 |
| 72100 |
|
25 |
25 |
$343.70 |
| 96375 |
|
962 |
776 |
$300.68 |
| J0696 |
Ceftriaxone sodium injection |
169 |
136 |
$272.65 |
| 93005 |
|
943 |
776 |
$247.59 |
| J7030 |
Normal saline solution infus |
1,531 |
1,232 |
$237.65 |
| 80048 |
|
33 |
32 |
$235.07 |
| J2550 |
Promethazine hcl injection |
116 |
108 |
$205.98 |
| 84443 |
|
14 |
14 |
$205.48 |
| J2405 |
Ondansetron hcl injection |
1,067 |
885 |
$197.07 |
| 73030 |
|
13 |
13 |
$146.16 |
| 36415 |
|
84 |
70 |
$139.87 |
| J2930 |
Methylprednisolone injection |
16 |
15 |
$107.80 |
| J3010 |
Fentanyl citrate injection |
255 |
200 |
$102.07 |
| 84439 |
|
12 |
12 |
$90.18 |
| J1100 |
Dexamethasone sodium phos |
62 |
60 |
$87.34 |
| J1200 |
Diphenhydramine hcl injectio |
129 |
116 |
$52.01 |
| 87426 |
|
49 |
39 |
$35.33 |
| J2704 |
Inj, propofol, 10 mg |
13 |
12 |
$33.33 |
| 85610 |
|
15 |
12 |
$30.63 |
| J2060 |
Lorazepam injection |
31 |
26 |
$16.33 |
| J2765 |
Metoclopramide hcl injection |
18 |
16 |
$9.29 |
| J7040 |
Normal saline solution infus |
137 |
86 |
$7.06 |
| J7620 |
Albuterol ipratrop non-comp |
51 |
46 |
$4.70 |
| 96372 |
|
17 |
15 |
$0.00 |
| Q0162 |
Ondansetron oral |
21 |
21 |
$0.00 |
| 96365 |
|
17 |
14 |
$0.00 |
| 80320 |
|
14 |
14 |
$0.00 |
| Q9966 |
Locm 200-299mg/ml iodine,1ml |
166 |
159 |
$0.00 |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
56 |
53 |
$0.00 |
| A9270 |
Non-covered item or service |
89 |
25 |
$-79.89 |