| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 0450 |
|
28,520 |
25,193 |
$2.91M |
| 99199 |
|
15,519 |
13,402 |
$1.84M |
| 99281 |
|
7,118 |
6,237 |
$938K |
| 96374 |
|
7,701 |
7,029 |
$806K |
| 74177 |
|
1,751 |
1,693 |
$701K |
| 70450 |
|
1,938 |
1,864 |
$568K |
| 87637 |
|
1,966 |
1,921 |
$441K |
| 0250 |
|
8,917 |
4,133 |
$432K |
| 96375 |
|
5,942 |
5,191 |
$429K |
| 80307 |
|
3,665 |
3,361 |
$419K |
| 80053 |
|
13,784 |
12,427 |
$408K |
| 87635 |
|
4,710 |
4,522 |
$379K |
| 93005 |
|
6,062 |
5,701 |
$296K |
| 82077 |
|
2,152 |
1,934 |
$285K |
| 96365 |
|
2,106 |
1,760 |
$267K |
| 85025 |
|
18,648 |
16,416 |
$247K |
| J3490 |
Drugs unclassified injection |
11,720 |
6,570 |
$236K |
| T1999 |
Noc retail items andsupplies |
6,059 |
2,997 |
$206K |
| 74176 |
|
962 |
928 |
$193K |
| 96372 |
|
3,964 |
3,422 |
$182K |
| 71046 |
|
3,931 |
3,796 |
$181K |
| Z7502 |
|
4,681 |
4,585 |
$177K |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
4,167 |
2,709 |
$168K |
| 80143 |
|
1,319 |
1,213 |
$166K |
| 96361 |
|
3,341 |
3,007 |
$158K |
| 80179 |
|
1,285 |
1,196 |
$157K |
| 87502 |
|
1,150 |
1,123 |
$134K |
| 71045 |
|
4,424 |
4,124 |
$119K |
| 96360 |
|
1,043 |
982 |
$108K |
| 99202 |
|
400 |
218 |
$108K |
| U0003 |
Cov-19 amp prb hgh thruput |
1,207 |
1,185 |
$99K |
| 80048 |
|
3,858 |
3,621 |
$94K |
| 96376 |
|
388 |
318 |
$94K |
| J7030 |
Normal saline solution infus |
7,094 |
6,330 |
$91K |
| 99283 |
|
1,372 |
1,167 |
$83K |
| 84484 |
|
4,622 |
3,675 |
$76K |
| 83690 |
|
5,159 |
4,785 |
$63K |
| 87636 |
|
269 |
268 |
$61K |
| J2405 |
Ondansetron hcl injection |
5,104 |
4,503 |
$54K |
| 73610 |
|
916 |
884 |
$51K |
| 87040 |
|
2,220 |
1,385 |
$50K |
| 87651 |
|
885 |
868 |
$48K |
| 73630 |
|
931 |
896 |
$48K |
| 87086 |
|
3,796 |
3,614 |
$46K |
| 83880 |
|
1,093 |
988 |
$46K |
| J1885 |
Ketorolac tromethamine inj |
4,268 |
4,013 |
$44K |
| 81001 |
|
6,303 |
5,943 |
$41K |
| 0270 |
|
998 |
481 |
$38K |
| 81025 |
|
3,497 |
3,374 |
$35K |
| 83735 |
|
2,793 |
2,478 |
$32K |
| 73110 |
|
577 |
530 |
$31K |
| 83605 |
|
1,742 |
1,432 |
$30K |
| J0131 |
Inj, acetaminophen (nos) |
809 |
486 |
$30K |
| 73562 |
|
615 |
597 |
$29K |
| J1170 |
Hydromorphone injection |
1,980 |
1,627 |
$29K |
| 76705 |
|
242 |
233 |
$28K |
| 94640 |
|
699 |
613 |
$27K |
| 82803 |
|
983 |
899 |
$26K |
| 72125 |
|
50 |
49 |
$25K |
| 73030 |
|
471 |
449 |
$25K |
| 87591 |
|
340 |
336 |
$24K |
| 81003 |
|
3,886 |
3,742 |
$23K |
| 87491 |
|
324 |
320 |
$22K |
| 84443 |
|
753 |
731 |
$21K |
| J0696 |
Ceftriaxone sodium injection |
1,569 |
1,385 |
$21K |
| 71260 |
|
41 |
39 |
$20K |
| 90715 |
|
273 |
272 |
$19K |
| 73130 |
|
306 |
293 |
$18K |
| 99284 |
|
235 |
225 |
$18K |
| 82330 |
|
690 |
585 |
$15K |
| 71275 |
|
56 |
54 |
$15K |
| J7120 |
Ringers lactate infusion |
1,085 |
959 |
$13K |
| 87634 |
|
111 |
110 |
$11K |
| U0005 |
Infec agen detec ampli probe |
467 |
465 |
$11K |
| 87077 |
|
1,109 |
1,007 |
$11K |
| J2060 |
Lorazepam injection |
1,014 |
863 |
$10K |
| 76856 |
|
70 |
70 |
$10K |
| 87186 |
|
1,106 |
1,031 |
$10K |
| 71250 |
|
53 |
52 |
$10K |
| 85610 |
|
1,594 |
1,464 |
$10K |
| 99285 |
|
61 |
60 |
$9K |
| 93971 |
|
30 |
30 |
$8K |
| 85379 |
|
371 |
363 |
$7K |
| 87430 |
|
370 |
367 |
$7K |
| J1200 |
Diphenhydramine hcl injectio |
682 |
609 |
$6K |
| J1100 |
Dexamethasone sodium phos |
507 |
487 |
$6K |
| 76830 |
|
26 |
26 |
$5K |
| 87400 |
|
427 |
419 |
$5K |
| J2270 |
Morphine sulfate injection |
333 |
281 |
$5K |
| 87081 |
|
347 |
341 |
$5K |
| 82947 |
|
669 |
543 |
$5K |
| 84702 |
|
341 |
316 |
$3K |
| 73502 |
|
56 |
51 |
$3K |
| J0137 |
Inj, acetaminophen (hikma) |
110 |
69 |
$3K |
| 85730 |
|
267 |
256 |
$2K |
| 0510 |
|
277 |
194 |
$2K |
| J3010 |
Fentanyl citrate injection |
235 |
230 |
$2K |
| J7050 |
Normal saline solution infus |
138 |
118 |
$2K |
| 73140 |
|
27 |
26 |
$1K |
| 84132 |
|
325 |
287 |
$917.80 |
| 84295 |
|
299 |
267 |
$871.62 |
| J2765 |
Metoclopramide hcl injection |
72 |
65 |
$712.53 |
| 87070 |
|
42 |
41 |
$664.43 |
| 72100 |
|
12 |
12 |
$642.45 |
| J2250 |
Inj midazolam hydrochloride |
73 |
72 |
$526.90 |
| J0780 |
Prochlorperazine injection |
16 |
13 |
$517.76 |
| J2919 |
Inj, methylpred sod succ 5mg |
14 |
12 |
$477.06 |
| 84703 |
|
331 |
324 |
$466.67 |
| J7040 |
Normal saline solution infus |
38 |
38 |
$349.03 |
| J2272 |
Inj, morphine (fresenius) |
13 |
13 |
$311.34 |
| 86900 |
|
59 |
36 |
$302.13 |
| 86901 |
|
53 |
37 |
$291.72 |
| 87147 |
|
21 |
12 |
$256.75 |
| S0028 |
Injection, famotidine, 20 mg |
12 |
12 |
$230.35 |
| 99282 |
|
12 |
12 |
$205.58 |
| 87420 |
|
14 |
14 |
$200.98 |
| 0761 |
|
13 |
12 |
$190.16 |
| J7512 |
Prednisone ir or dr oral 1mg |
171 |
168 |
$165.95 |
| J2704 |
Inj, propofol, 10 mg |
26 |
24 |
$165.03 |
| J3475 |
Inj magnesium sulfate |
13 |
12 |
$151.83 |
| 86308 |
|
15 |
14 |
$140.23 |
| 87205 |
|
15 |
14 |
$136.35 |
| J2550 |
Promethazine hcl injection |
14 |
12 |
$119.38 |
| 90471 |
|
19 |
18 |
$107.04 |
| J7611 |
Albuterol non-comp con |
39 |
37 |
$80.02 |
| J2470 |
Inj pantoprazole sodium 40mg |
13 |
13 |
$50.19 |
| 85652 |
|
14 |
14 |
$49.73 |
| 86140 |
|
12 |
12 |
$47.08 |
| 36415 |
|
19 |
12 |
$5.88 |
| J7620 |
Albuterol ipratrop non-comp |
52 |
46 |
$2.34 |
| Q0162 |
Ondansetron oral |
140 |
138 |
$1.62 |