| Code | Description | Claims | Beneficiaries | Total Paid |
| H0046 |
Mental health service, nos |
10,786 |
2,789 |
$1.04M |
| 90837 |
|
4,652 |
2,927 |
$545K |
| H0034 |
Med trng & support per 15min |
3,635 |
3,347 |
$310K |
| 90834 |
|
2,403 |
1,896 |
$225K |
| 99201 |
|
1,765 |
1,722 |
$197K |
| 99241 |
|
871 |
854 |
$97K |
| 99285 |
|
574 |
550 |
$87K |
| 90792 |
|
714 |
691 |
$69K |
| 99284 |
|
477 |
460 |
$58K |
| 99283 |
|
447 |
434 |
$36K |
| G0378 |
Hospital observation per hr |
28 |
28 |
$29K |
| U0003 |
Cov-19 amp prb hgh thruput |
287 |
260 |
$26K |
| T1015 |
Clinic service |
578 |
168 |
$25K |
| 90832 |
|
532 |
459 |
$23K |
| 99211 |
|
517 |
471 |
$21K |
| 74177 |
|
103 |
103 |
$20K |
| 87428 |
|
329 |
325 |
$18K |
| 0012A |
|
259 |
259 |
$11K |
| 80050 |
|
224 |
222 |
$11K |
| 80307 |
|
184 |
170 |
$11K |
| 87635 |
|
253 |
247 |
$9K |
| 96374 |
|
325 |
305 |
$9K |
| 0011A |
|
226 |
225 |
$8K |
| 82306 |
|
190 |
188 |
$7K |
| 77067 |
|
89 |
89 |
$7K |
| 80048 |
|
898 |
822 |
$7K |
| 72148 |
|
33 |
33 |
$6K |
| 70450 |
|
101 |
100 |
$6K |
| 85025 |
|
1,451 |
1,330 |
$6K |
| 80061 |
|
409 |
407 |
$6K |
| 84443 |
|
429 |
424 |
$6K |
| 80053 |
|
656 |
635 |
$5K |
| 71260 |
|
53 |
53 |
$5K |
| 0013A |
|
100 |
100 |
$4K |
| 96375 |
|
236 |
206 |
$4K |
| 93306 |
|
53 |
53 |
$4K |
| 73721 |
|
15 |
15 |
$4K |
| 72141 |
|
12 |
12 |
$4K |
| 99213 |
|
84 |
78 |
$4K |
| 97162 |
|
49 |
49 |
$3K |
| 96365 |
|
94 |
91 |
$3K |
| 93005 |
|
363 |
338 |
$3K |
| 76830 |
|
68 |
68 |
$3K |
| 80076 |
|
339 |
317 |
$3K |
| 11042 |
|
98 |
60 |
$3K |
| 71046 |
|
195 |
193 |
$3K |
| 99212 |
|
59 |
53 |
$3K |
| 87086 |
|
282 |
266 |
$2K |
| 99282 |
|
59 |
59 |
$2K |
| 76856 |
|
41 |
41 |
$2K |
| 71045 |
|
322 |
307 |
$2K |
| 77063 |
|
89 |
89 |
$2K |
| 82607 |
|
136 |
131 |
$2K |
| 84466 |
|
101 |
98 |
$2K |
| 87081 |
|
308 |
305 |
$2K |
| 83036 |
|
234 |
234 |
$2K |
| 84484 |
|
206 |
188 |
$2K |
| 43239 |
|
13 |
13 |
$2K |
| 81001 |
|
574 |
545 |
$2K |
| 82728 |
|
120 |
114 |
$2K |
| 96372 |
|
107 |
95 |
$1K |
| 0003A |
|
33 |
33 |
$1K |
| 76536 |
|
26 |
26 |
$1K |
| 59025 |
|
110 |
64 |
$1K |
| 76705 |
|
35 |
35 |
$1K |
| 76816 |
|
29 |
29 |
$1K |
| 76642 |
|
27 |
27 |
$1K |
| 74176 |
|
12 |
12 |
$1K |
| 84702 |
|
69 |
59 |
$1K |
| 0001A |
|
27 |
27 |
$1K |
| 83690 |
|
259 |
238 |
$1K |
| 84153 |
|
43 |
43 |
$1K |
| 88342 |
|
27 |
27 |
$1K |
| 86618 |
|
44 |
22 |
$1K |
| 88305 |
|
78 |
78 |
$1K |
| 76817 |
|
18 |
15 |
$1K |
| 93017 |
|
27 |
27 |
$954.18 |
| 86803 |
|
45 |
45 |
$931.38 |
| 84439 |
|
109 |
106 |
$930.24 |
| 83735 |
|
151 |
141 |
$904.22 |
| 83540 |
|
98 |
95 |
$896.52 |
| 87186 |
|
91 |
87 |
$893.76 |
| 76700 |
|
12 |
12 |
$786.60 |
| 85027 |
|
121 |
118 |
$762.73 |
| 87040 |
|
64 |
33 |
$734.16 |
| P9604 |
One-way allow prorated trip |
83 |
41 |
$708.90 |
| 73564 |
|
28 |
28 |
$702.90 |
| 87389 |
|
35 |
35 |
$684.64 |
| 87150 |
|
14 |
14 |
$641.90 |
| 93296 |
|
75 |
74 |
$641.19 |
| 76775 |
|
13 |
12 |
$614.46 |
| 82043 |
|
68 |
68 |
$601.92 |
| 82570 |
|
82 |
82 |
$588.59 |
| 82746 |
|
38 |
37 |
$506.16 |
| 85610 |
|
164 |
128 |
$505.02 |
| 84146 |
|
16 |
16 |
$465.12 |
| 85730 |
|
74 |
73 |
$461.70 |
| 84481 |
|
17 |
15 |
$453.73 |
| 74019 |
|
28 |
28 |
$450.96 |
| 82784 |
|
25 |
25 |
$424.85 |
| 74018 |
|
30 |
30 |
$423.90 |
| 96361 |
|
50 |
46 |
$420.66 |
| 73610 |
|
19 |
18 |
$373.63 |
| 97597 |
|
18 |
15 |
$359.50 |
| 86038 |
|
23 |
23 |
$359.10 |
| 73130 |
|
27 |
26 |
$350.71 |
| 86255 |
|
15 |
14 |
$336.60 |
| 87077 |
|
36 |
35 |
$331.69 |
| 87591 |
|
14 |
14 |
$317.28 |
| 87491 |
|
14 |
14 |
$317.28 |
| 83880 |
|
14 |
14 |
$302.75 |
| 87088 |
|
32 |
29 |
$291.84 |
| 73630 |
|
27 |
27 |
$278.76 |
| G0463 |
Hospital outpt clinic visit |
84 |
77 |
$278.34 |
| 86850 |
|
33 |
33 |
$260.28 |
| 85652 |
|
84 |
79 |
$259.92 |
| 73030 |
|
13 |
13 |
$244.53 |
| 87340 |
|
18 |
18 |
$226.24 |
| 87070 |
|
35 |
35 |
$224.10 |
| 85379 |
|
21 |
21 |
$217.44 |
| 86225 |
|
13 |
13 |
$214.89 |
| 83615 |
|
30 |
27 |
$213.20 |
| 86140 |
|
62 |
57 |
$194.94 |
| 84436 |
|
21 |
21 |
$173.28 |
| 81025 |
|
73 |
71 |
$173.28 |
| 84703 |
|
15 |
15 |
$152.10 |
| 84550 |
|
23 |
23 |
$149.31 |
| 82550 |
|
17 |
16 |
$131.20 |
| 82565 |
|
19 |
19 |
$124.27 |
| 86431 |
|
16 |
16 |
$123.34 |
| 84480 |
|
16 |
16 |
$118.56 |
| 86901 |
|
32 |
31 |
$114.24 |
| 86900 |
|
32 |
31 |
$112.56 |
| 84520 |
|
16 |
16 |
$93.00 |
| 83605 |
|
13 |
13 |
$91.20 |
| 87147 |
|
20 |
20 |
$82.08 |
| 86592 |
|
22 |
22 |
$82.08 |
| 82948 |
|
150 |
78 |
$75.24 |
| J3490 |
Drugs unclassified injection |
448 |
348 |
$36.88 |
| 82274 |
|
12 |
12 |
$35.09 |
| J1885 |
Ketorolac tromethamine inj |
868 |
795 |
$0.00 |
| J0690 |
Cefazolin sodium injection |
229 |
183 |
$0.00 |
| J3010 |
Fentanyl citrate injection |
644 |
557 |
$0.00 |
| J2250 |
Inj midazolam hydrochloride |
569 |
557 |
$0.00 |
| J0131 |
Inj, acetaminophen (nos) |
125 |
117 |
$0.00 |
| J2704 |
Inj, propofol, 10 mg |
890 |
850 |
$0.00 |
| A9579 |
Gad-base mr contrast nos,1ml |
135 |
133 |
$0.00 |
| J1170 |
Hydromorphone injection |
483 |
381 |
$0.00 |
| J2060 |
Lorazepam injection |
131 |
108 |
$0.00 |
| 96376 |
|
76 |
53 |
$0.00 |
| J1100 |
Dexamethasone sodium phos |
532 |
521 |
$0.00 |
| J2001 |
Lidocaine injection |
160 |
158 |
$0.00 |
| J0696 |
Ceftriaxone sodium injection |
25 |
25 |
$0.00 |
| 36415 |
|
1,415 |
1,227 |
$0.00 |
| J1790 |
Droperidol injection |
13 |
13 |
$0.00 |
| 94640 |
|
50 |
50 |
$0.00 |
| J2765 |
Metoclopramide hcl injection |
28 |
25 |
$0.00 |
| A9270 |
Non-covered item or service |
32 |
16 |
$0.00 |
| 83516 |
|
25 |
25 |
$0.00 |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
935 |
883 |
$0.00 |
| 87420 |
|
12 |
12 |
$0.00 |
| J2405 |
Ondansetron hcl injection |
1,419 |
1,270 |
$0.00 |
| J7120 |
Ringers lactate infusion |
547 |
525 |
$0.00 |
| J1200 |
Diphenhydramine hcl injectio |
226 |
209 |
$0.00 |
| J1644 |
Inj heparin sodium per 1000u |
29 |
25 |
$0.00 |
| J2930 |
Methylprednisolone injection |
26 |
26 |
$0.00 |
| J7030 |
Normal saline solution infus |
80 |
78 |
$0.00 |
| J2270 |
Morphine sulfate injection |
49 |
44 |
$0.00 |
| Q9966 |
Locm 200-299mg/ml iodine,1ml |
13 |
13 |
$0.00 |
| 97110 |
|
48 |
14 |
$0.00 |