| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99284 |
|
3,152 |
2,596 |
$225K |
| 99283 |
|
4,475 |
3,641 |
$218K |
| 99282 |
|
1,359 |
1,195 |
$87K |
| 99285 |
|
872 |
724 |
$77K |
| G0463 |
Hospital outpt clinic visit |
7,418 |
2,843 |
$73K |
| J3490 |
Drugs unclassified injection |
1,595 |
990 |
$56K |
| A9270 |
Non-covered item or service |
1,138 |
172 |
$22K |
| 93005 |
|
1,701 |
158 |
$20K |
| C9803 |
Hopd covid-19 spec collect |
95 |
89 |
$9K |
| 00170 |
|
54 |
49 |
$6K |
| 97530 |
|
78 |
26 |
$3K |
| 93010 |
|
306 |
266 |
$2K |
| 85025 |
|
114 |
106 |
$1K |
| 36415 |
|
14 |
12 |
$1K |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
44 |
13 |
$717.00 |
| 80053 |
|
64 |
58 |
$606.56 |
| G0008 |
Admin influenza virus vac |
89 |
15 |
$254.13 |
| U0003 |
Cov-19 amp prb hgh thruput |
123 |
101 |
$179.71 |
| J7120 |
Ringers lactate infusion |
31 |
24 |
$0.00 |
| J2405 |
Ondansetron hcl injection |
13 |
12 |
$0.00 |
| J1100 |
Dexamethasone sodium phos |
28 |
24 |
$0.00 |
| J2704 |
Inj, propofol, 10 mg |
32 |
24 |
$0.00 |