| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99284 |
|
3,779 |
3,434 |
$933K |
| 99281 |
|
9,926 |
7,994 |
$670K |
| 99283 |
|
3,600 |
3,211 |
$667K |
| 99285 |
|
868 |
817 |
$661K |
| A9150 |
Misc/exper non-prescript dru |
3,265 |
1,272 |
$545K |
| 80053 |
|
7,438 |
6,831 |
$400K |
| T1999 |
Noc retail items andsupplies |
8,002 |
4,890 |
$360K |
| 0510 |
|
5,175 |
3,753 |
$324K |
| 96374 |
|
2,746 |
2,485 |
$309K |
| 70450 |
|
1,465 |
1,408 |
$248K |
| 0450 |
|
1,935 |
1,722 |
$181K |
| 0241U |
|
955 |
932 |
$179K |
| G0481 |
Drug test def 8-14 classes |
990 |
960 |
$152K |
| 93005 |
|
5,073 |
4,599 |
$123K |
| 99199 |
|
1,817 |
1,612 |
$116K |
| 71045 |
|
2,584 |
2,439 |
$113K |
| 96372 |
|
1,773 |
1,505 |
$108K |
| 74177 |
|
261 |
255 |
$107K |
| G0463 |
Hospital outpt clinic visit |
8,035 |
6,285 |
$96K |
| 96375 |
|
1,728 |
1,502 |
$91K |
| 96361 |
|
1,903 |
1,782 |
$79K |
| U0002 |
Covid-19 lab test non-cdc |
948 |
918 |
$78K |
| 99282 |
|
407 |
363 |
$72K |
| 85025 |
|
8,805 |
7,624 |
$63K |
| 96365 |
|
482 |
458 |
$60K |
| J3490 |
Drugs unclassified injection |
2,542 |
1,673 |
$57K |
| 71046 |
|
1,076 |
1,031 |
$53K |
| 97110 |
|
1,978 |
617 |
$49K |
| 80048 |
|
1,818 |
1,523 |
$43K |
| 84484 |
|
3,017 |
2,674 |
$39K |
| 96360 |
|
378 |
359 |
$37K |
| 0760 |
|
506 |
477 |
$34K |
| 97139 |
|
1,439 |
300 |
$31K |
| 82962 |
|
2,729 |
2,216 |
$28K |
| J7030 |
Normal saline solution infus |
2,477 |
2,267 |
$20K |
| 36415 |
|
3,078 |
2,725 |
$17K |
| 83880 |
|
469 |
448 |
$16K |
| 94760 |
|
3,911 |
3,434 |
$16K |
| 84443 |
|
748 |
736 |
$15K |
| 83036 |
|
1,425 |
1,400 |
$14K |
| G0480 |
Drug test def 1-7 classes |
81 |
78 |
$14K |
| 97140 |
|
264 |
111 |
$13K |
| 81001 |
|
1,715 |
1,646 |
$13K |
| 80061 |
|
1,020 |
1,014 |
$12K |
| 83690 |
|
1,838 |
1,754 |
$11K |
| 80047 |
|
114 |
110 |
$10K |
| 87635 |
|
128 |
120 |
$10K |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
635 |
600 |
$8K |
| 0270 |
|
604 |
268 |
$7K |
| 90686 |
|
465 |
460 |
$7K |
| A9270 |
Non-covered item or service |
1,862 |
1,061 |
$7K |
| 90674 |
|
307 |
306 |
$6K |
| J2405 |
Ondansetron hcl injection |
1,082 |
983 |
$6K |
| 87502 |
|
88 |
87 |
$6K |
| J1885 |
Ketorolac tromethamine inj |
811 |
758 |
$5K |
| 87086 |
|
391 |
373 |
$5K |
| 83605 |
|
474 |
438 |
$4K |
| 96413 |
|
55 |
36 |
$4K |
| 85610 |
|
877 |
749 |
$3K |
| 81003 |
|
230 |
223 |
$3K |
| 90471 |
|
755 |
748 |
$3K |
| 77067 |
|
41 |
41 |
$3K |
| 97750 |
|
67 |
39 |
$3K |
| 83735 |
|
471 |
408 |
$3K |
| 81002 |
|
161 |
158 |
$3K |
| U0003 |
Cov-19 amp prb hgh thruput |
14 |
12 |
$2K |
| Z7502 |
|
54 |
53 |
$2K |
| J2270 |
Morphine sulfate injection |
321 |
279 |
$2K |
| 72131 |
|
14 |
13 |
$2K |
| 81025 |
|
136 |
133 |
$2K |
| 0002A |
|
47 |
47 |
$2K |
| 97530 |
|
17 |
12 |
$1K |
| 90715 |
|
39 |
39 |
$1K |
| 87631 |
|
12 |
12 |
$888.05 |
| G0108 |
Diab manage trn per indiv |
31 |
27 |
$887.53 |
| 77063 |
|
39 |
39 |
$818.05 |
| 0001A |
|
43 |
43 |
$686.07 |
| 87040 |
|
71 |
56 |
$625.89 |
| 0003A |
|
15 |
15 |
$600.00 |
| 82306 |
|
27 |
27 |
$552.27 |
| 87804 |
|
62 |
60 |
$523.01 |
| 71020 |
|
29 |
29 |
$485.19 |
| J2060 |
Lorazepam injection |
73 |
64 |
$400.26 |
| 94640 |
|
33 |
30 |
$337.61 |
| 87801 |
|
13 |
12 |
$309.26 |
| 82043 |
|
26 |
26 |
$184.42 |
| J1170 |
Hydromorphone injection |
31 |
28 |
$178.42 |
| 87186 |
|
41 |
39 |
$156.31 |
| 85027 |
|
42 |
39 |
$143.28 |
| 85730 |
|
51 |
51 |
$139.95 |
| 71010 |
|
14 |
14 |
$93.42 |
| J0696 |
Ceftriaxone sodium injection |
12 |
12 |
$92.16 |
| 91300 |
|
13 |
12 |
$0.08 |
| 90472 |
|
14 |
14 |
$0.00 |
| G0008 |
Admin influenza virus vac |
366 |
361 |
$0.00 |