| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic service |
932,656 |
730,225 |
$13.19M |
| J0585 |
Injection,onabotulinumtoxina |
4,095 |
3,359 |
$10.68M |
| 87633 |
|
28,879 |
25,104 |
$7.41M |
| J1745 |
Infliximab not biosimil 10mg |
2,531 |
1,900 |
$5.67M |
| 70551 |
|
12,152 |
10,304 |
$5.47M |
| U0002 |
Covid-19 lab test non-cdc |
68,435 |
57,679 |
$4.74M |
| 0241U |
|
29,483 |
25,878 |
$4.36M |
| 93306 |
|
11,824 |
10,517 |
$3.58M |
| 93303 |
|
18,896 |
16,075 |
$2.85M |
| 43239 |
|
6,543 |
5,681 |
$2.72M |
| 70553 |
|
4,214 |
3,421 |
$2.60M |
| 87798 |
|
29,072 |
25,227 |
$2.33M |
| 70450 |
|
11,407 |
9,629 |
$2.25M |
| 82306 |
|
32,757 |
29,204 |
$1.90M |
| 96365 |
|
19,540 |
10,761 |
$1.70M |
| 42820 |
|
4,295 |
4,012 |
$1.66M |
| 87651 |
|
29,619 |
26,058 |
$1.57M |
| 95716 |
|
2,006 |
1,458 |
$1.51M |
| 80053 |
|
75,220 |
57,652 |
$1.45M |
| 72141 |
|
3,000 |
2,550 |
$1.42M |
| 88305 |
|
10,403 |
9,079 |
$1.42M |
| 85025 |
|
114,125 |
88,340 |
$1.42M |
| 72148 |
|
2,770 |
2,354 |
$1.36M |
| 87581 |
|
28,329 |
24,726 |
$1.34M |
| 87486 |
|
28,335 |
24,727 |
$1.34M |
| 72146 |
|
2,399 |
2,039 |
$1.25M |
| 70543 |
|
1,233 |
987 |
$1.23M |
| 87591 |
|
17,791 |
14,924 |
$1.23M |
| 87491 |
|
17,759 |
14,891 |
$1.22M |
| 95782 |
|
2,145 |
1,929 |
$1.21M |
| 97110 |
|
19,130 |
7,348 |
$1.20M |
| 95810 |
|
4,845 |
4,365 |
$1.13M |
| 71046 |
|
42,262 |
36,016 |
$1.04M |
| 87661 |
|
14,745 |
12,885 |
$1.02M |
| 93320 |
|
19,042 |
16,115 |
$966K |
| 69436 |
|
3,682 |
3,533 |
$960K |
| 36512 |
|
2,693 |
1,957 |
$953K |
| 90686 |
|
58,533 |
49,260 |
$908K |
| 93005 |
|
40,341 |
34,464 |
$857K |
| 84443 |
|
28,278 |
25,270 |
$857K |
| 74177 |
|
3,223 |
2,673 |
$855K |
| 80307 |
|
6,119 |
5,185 |
$852K |
| 73721 |
|
1,955 |
1,681 |
$830K |
| 77080 |
|
2,833 |
2,566 |
$786K |
| 86003 |
|
8,540 |
7,523 |
$781K |
| 80050 |
|
9,799 |
8,841 |
$761K |
| 94010 |
|
25,502 |
23,211 |
$753K |
| 41899 |
|
1,124 |
636 |
$726K |
| 76770 |
|
13,819 |
12,364 |
$708K |
| 83036 |
|
33,301 |
29,508 |
$663K |
| 42830 |
|
1,930 |
1,866 |
$657K |
| 80061 |
|
23,894 |
21,439 |
$642K |
| J0475 |
Baclofen 10 mg injection |
191 |
164 |
$622K |
| 72082 |
|
9,441 |
8,443 |
$621K |
| 82728 |
|
23,772 |
20,248 |
$601K |
| 95819 |
|
7,482 |
6,813 |
$600K |
| 51798 |
|
2,293 |
2,023 |
$595K |
| 54161 |
|
2,285 |
2,146 |
$583K |
| 86901 |
|
13,666 |
8,125 |
$578K |
| 84439 |
|
31,405 |
28,208 |
$573K |
| 71260 |
|
2,004 |
1,630 |
$507K |
| 80048 |
|
30,681 |
24,445 |
$504K |
| 70486 |
|
1,794 |
1,584 |
$415K |
| 92611 |
|
9,454 |
8,600 |
$404K |
| 87086 |
|
28,686 |
24,990 |
$396K |
| 81025 |
|
32,008 |
26,531 |
$390K |
| 93325 |
|
22,001 |
18,661 |
$389K |
| 90670 |
|
33,614 |
31,553 |
$377K |
| J7307 |
Etonogestrel implant system |
512 |
309 |
$376K |
| 84145 |
|
12,718 |
10,577 |
$376K |
| J1569 |
Gammagard liquid injection |
470 |
183 |
$369K |
| 74022 |
|
9,554 |
8,362 |
$365K |
| 87804 |
|
19,943 |
14,792 |
$364K |
| 87631 |
|
2,430 |
2,298 |
$351K |
| 95700 |
|
2,083 |
1,749 |
$350K |
| 80069 |
|
17,237 |
12,365 |
$350K |
| 83970 |
|
5,061 |
4,337 |
$336K |
| 72125 |
|
1,081 |
935 |
$330K |
| 74018 |
|
11,379 |
10,178 |
$327K |
| 85027 |
|
34,623 |
27,282 |
$321K |
| 86140 |
|
37,583 |
31,028 |
$320K |
| 90647 |
|
27,491 |
25,706 |
$314K |
| 93975 |
|
2,488 |
2,114 |
$309K |
| 97163 |
|
1,233 |
1,149 |
$309K |
| 93226 |
|
3,651 |
3,151 |
$308K |
| 90651 |
|
19,639 |
17,121 |
$306K |
| 74019 |
|
9,609 |
8,153 |
$301K |
| 72170 |
|
9,429 |
8,276 |
$297K |
| 82803 |
|
7,840 |
5,891 |
$293K |
| 81229 |
|
736 |
572 |
$292K |
| 73630 |
|
8,128 |
5,987 |
$286K |
| 83516 |
|
10,072 |
9,024 |
$281K |
| 0071A |
|
2,531 |
2,313 |
$275K |
| 44970 |
|
661 |
546 |
$271K |
| 90723 |
|
25,419 |
24,107 |
$271K |
| 87077 |
|
15,456 |
13,113 |
$270K |
| 36430 |
|
1,524 |
829 |
$268K |
| 74230 |
|
9,992 |
9,072 |
$268K |
| 87497 |
|
4,587 |
2,999 |
$267K |
| 82784 |
|
19,716 |
16,472 |
$262K |
| 87389 |
|
2,528 |
2,280 |
$260K |
| 88185 |
|
2,405 |
2,054 |
$255K |
| 76705 |
|
10,661 |
9,018 |
$255K |
| 83880 |
|
4,961 |
3,759 |
$246K |
| 90633 |
|
22,803 |
20,924 |
$244K |
| 77073 |
|
5,756 |
4,100 |
$243K |
| 92523 |
|
6,459 |
5,372 |
$241K |
| 87040 |
|
15,431 |
12,547 |
$241K |
| 49452 |
|
265 |
213 |
$239K |
| 82248 |
|
31,602 |
22,812 |
$239K |
| 0072A |
|
2,108 |
1,933 |
$238K |
| 81003 |
|
60,977 |
49,175 |
$237K |
| 83735 |
|
21,106 |
13,952 |
$236K |
| 92587 |
|
4,776 |
4,396 |
$234K |
| 97162 |
|
1,447 |
1,284 |
$230K |
| J1561 |
Gamunex-c/gammaked |
307 |
215 |
$221K |
| 67311 |
|
472 |
447 |
$220K |
| 86780 |
|
7,758 |
6,804 |
$219K |
| 70480 |
|
928 |
831 |
$218K |
| 90681 |
|
19,712 |
18,650 |
$218K |
| 31526 |
|
645 |
590 |
$216K |
| 73130 |
|
5,830 |
4,520 |
$215K |
| 97530 |
|
3,797 |
1,357 |
$215K |
| 82948 |
|
25,834 |
20,184 |
$215K |
| 84703 |
|
14,631 |
11,409 |
$214K |
| 0001A |
|
3,079 |
2,803 |
$214K |
| 81001 |
|
39,315 |
33,005 |
$209K |
| 70491 |
|
883 |
725 |
$205K |
| 83020 |
|
8,801 |
6,836 |
$204K |
| 87070 |
|
14,955 |
11,952 |
$202K |
| 73564 |
|
4,600 |
3,821 |
$201K |
| 29405 |
|
606 |
543 |
$199K |
| 90619 |
|
4,208 |
3,731 |
$198K |
| 73590 |
|
7,106 |
5,357 |
$194K |
| J2405 |
Ondansetron hcl injection |
12,199 |
5,524 |
$194K |
| 82977 |
|
15,941 |
12,787 |
$192K |
| 76700 |
|
2,897 |
2,531 |
$190K |
| 92567 |
|
12,464 |
11,127 |
$177K |
| J1050 |
Medroxyprogesterone acetate |
7,538 |
6,592 |
$175K |
| 93225 |
|
3,938 |
3,382 |
$174K |
| 80197 |
|
8,664 |
4,953 |
$173K |
| 73610 |
|
7,657 |
6,180 |
$172K |
| 88342 |
|
2,947 |
2,489 |
$172K |
| 95951 |
|
1,356 |
837 |
$168K |
| 76376 |
|
6,277 |
5,497 |
$167K |
| 82330 |
|
5,160 |
3,179 |
$165K |
| 90715 |
|
10,559 |
9,441 |
$162K |
| 73090 |
|
8,035 |
5,626 |
$161K |
| 76536 |
|
2,597 |
2,294 |
$158K |
| 87880 |
|
11,433 |
10,159 |
$156K |
| 70250 |
|
5,446 |
4,354 |
$155K |
| 76856 |
|
3,011 |
2,567 |
$154K |
| 84305 |
|
3,742 |
3,467 |
$153K |
| 90734 |
|
10,633 |
9,374 |
$151K |
| J9370 |
Vincristine sulfate 1 mg inj |
4,080 |
2,154 |
$150K |
| 72081 |
|
4,451 |
3,923 |
$149K |
| 77072 |
|
4,319 |
4,033 |
$147K |
| 72197 |
|
146 |
126 |
$147K |
| 73110 |
|
5,001 |
3,926 |
$144K |
| 85046 |
|
16,313 |
12,319 |
$137K |
| 76820 |
|
2,497 |
2,254 |
$137K |
| 83550 |
|
8,640 |
7,196 |
$136K |
| 0002A |
|
1,547 |
1,491 |
$135K |
| 86160 |
|
3,632 |
2,993 |
$134K |
| 73560 |
|
4,339 |
3,182 |
$133K |
| 76821 |
|
2,486 |
2,247 |
$132K |
| 88184 |
|
2,748 |
2,331 |
$132K |
| 97161 |
|
1,260 |
1,057 |
$131K |
| 84100 |
|
16,142 |
10,795 |
$130K |
| 83615 |
|
14,405 |
11,509 |
$129K |
| 76885 |
|
2,541 |
2,297 |
$129K |
| 92507 |
|
7,079 |
2,671 |
$128K |
| 84146 |
|
2,654 |
2,378 |
$127K |
| 76825 |
|
3,334 |
2,080 |
$125K |
| 83690 |
|
10,563 |
8,647 |
$124K |
| 51600 |
|
842 |
488 |
$123K |
| 90700 |
|
11,146 |
10,261 |
$122K |
| 86376 |
|
3,967 |
3,633 |
$120K |
| 76827 |
|
3,411 |
2,084 |
$118K |
| 82785 |
|
5,220 |
4,567 |
$117K |
| 87186 |
|
9,712 |
8,381 |
$117K |
| 90716 |
|
10,894 |
9,982 |
$117K |
| 83540 |
|
9,201 |
7,959 |
$116K |
| 94060 |
|
2,703 |
2,406 |
$115K |
| 86922 |
|
780 |
444 |
$115K |
| 90707 |
|
10,607 |
9,763 |
$114K |
| 84460 |
|
12,168 |
10,253 |
$113K |
| 90697 |
|
8,002 |
7,529 |
$113K |
| J3262 |
Tocilizumab injection |
56 |
37 |
$113K |
| 93978 |
|
1,107 |
1,000 |
$112K |
| 86703 |
|
7,519 |
6,147 |
$111K |
| 86800 |
|
3,384 |
3,102 |
$111K |
| 85652 |
|
22,481 |
18,912 |
$110K |
| 93786 |
|
1,988 |
1,815 |
$110K |
| 74181 |
|
210 |
177 |
$110K |
| 73562 |
|
2,358 |
1,766 |
$109K |
| 90710 |
|
9,866 |
9,177 |
$109K |
| 86902 |
|
2,646 |
1,732 |
$106K |
| 73080 |
|
4,886 |
3,827 |
$104K |
| 80335 |
|
1,861 |
1,544 |
$104K |
| 83001 |
|
2,671 |
2,397 |
$102K |
| 83002 |
|
2,685 |
2,424 |
$102K |
| 73552 |
|
4,473 |
3,417 |
$100K |
| 90620 |
|
3,663 |
3,078 |
$100K |
| 85730 |
|
10,110 |
7,878 |
$98K |
| 80076 |
|
6,125 |
5,277 |
$95K |
| 75561 |
|
187 |
142 |
$95K |
| 86665 |
|
1,674 |
1,465 |
$94K |
| 73100 |
|
4,624 |
3,324 |
$94K |
| 82533 |
|
2,384 |
2,017 |
$93K |
| 85610 |
|
14,350 |
11,137 |
$93K |
| 90696 |
|
8,324 |
7,792 |
$91K |
| 29075 |
|
605 |
533 |
$90K |
| 77075 |
|
1,427 |
1,232 |
$90K |
| 86923 |
|
4,339 |
2,766 |
$88K |
| 0081A |
|
928 |
876 |
$87K |
| 95816 |
|
2,150 |
1,933 |
$86K |
| 97001 |
|
2,887 |
2,318 |
$85K |
| 86803 |
|
3,400 |
2,865 |
$85K |
| 73140 |
|
4,578 |
3,652 |
$84K |
| 87088 |
|
8,406 |
6,916 |
$82K |
| 84450 |
|
8,442 |
7,444 |
$81K |
| 72040 |
|
2,234 |
1,954 |
$81K |
| 95812 |
|
692 |
640 |
$81K |
| 72100 |
|
2,209 |
1,935 |
$80K |
| 90688 |
|
8,750 |
8,245 |
$78K |
| 82962 |
|
11,148 |
8,077 |
$76K |
| 72156 |
|
159 |
118 |
$76K |
| 87506 |
|
245 |
223 |
$76K |
| 74183 |
|
63 |
43 |
$75K |
| 73030 |
|
2,922 |
2,369 |
$75K |
| 76882 |
|
4,801 |
2,729 |
$74K |
| 82150 |
|
6,611 |
5,305 |
$72K |
| 87799 |
|
1,623 |
1,041 |
$72K |
| 72158 |
|
131 |
95 |
$71K |
| 85660 |
|
6,130 |
2,133 |
$71K |
| 93976 |
|
822 |
714 |
$70K |
| 82550 |
|
5,911 |
4,902 |
$69K |
| 82607 |
|
2,194 |
1,939 |
$69K |
| 86900 |
|
11,911 |
8,089 |
$67K |
| 88307 |
|
1,099 |
874 |
$66K |
| 87081 |
|
5,893 |
5,385 |
$66K |
| 76870 |
|
1,798 |
1,570 |
$65K |
| 90671 |
|
6,437 |
4,806 |
$64K |
| 93788 |
|
2,091 |
1,859 |
$64K |
| 82043 |
|
5,174 |
4,657 |
$63K |
| 0124A |
|
1,091 |
980 |
$62K |
| 87340 |
|
3,203 |
2,771 |
$62K |
| 82810 |
|
2,856 |
1,035 |
$61K |
| 87045 |
|
4,251 |
3,674 |
$61K |
| 80074 |
|
545 |
502 |
$60K |
| 83930 |
|
3,774 |
3,075 |
$60K |
| 73070 |
|
3,365 |
2,522 |
$60K |
| 80143 |
|
1,522 |
1,257 |
$58K |
| 87483 |
|
148 |
114 |
$58K |
| 86850 |
|
10,532 |
7,405 |
$58K |
| J2930 |
Methylprednisolone injection |
1,406 |
923 |
$58K |
| 73060 |
|
2,304 |
1,748 |
$57K |
| 88304 |
|
2,216 |
1,827 |
$56K |
| 72157 |
|
113 |
81 |
$56K |
| 31541 |
|
286 |
240 |
$56K |
| 86255 |
|
2,717 |
2,370 |
$55K |
| 86706 |
|
2,667 |
2,289 |
$53K |
| 80179 |
|
1,385 |
1,161 |
$53K |
| 85007 |
|
11,976 |
7,972 |
$52K |
| 82247 |
|
9,916 |
4,881 |
$52K |
| 87150 |
|
126 |
25 |
$52K |
| 0082A |
|
528 |
518 |
$52K |
| 0052A |
|
675 |
432 |
$52K |
| 92588 |
|
1,077 |
940 |
$52K |
| 71045 |
|
3,601 |
2,813 |
$50K |
| 86364 |
|
3,079 |
2,896 |
$50K |
| 82105 |
|
2,031 |
1,678 |
$50K |
| 31561 |
|
205 |
199 |
$48K |
| 72070 |
|
1,448 |
1,277 |
$48K |
| 43762 |
|
118 |
115 |
$48K |
| 72195 |
|
89 |
77 |
$47K |
| 20680 |
|
150 |
130 |
$47K |
| 87205 |
|
7,068 |
5,116 |
$47K |
| 87427 |
|
3,503 |
3,034 |
$46K |
| A9575 |
Inj gadoterate meglumi 0.1ml |
959 |
485 |
$46K |
| 82010 |
|
2,516 |
1,666 |
$45K |
| 82077 |
|
1,333 |
1,104 |
$45K |
| 84480 |
|
1,416 |
1,286 |
$44K |
| 0051A |
|
606 |
395 |
$44K |
| 93886 |
|
644 |
582 |
$44K |
| 87529 |
|
856 |
661 |
$43K |
| 85576 |
|
435 |
393 |
$42K |
| J9260 |
Inj methotrexate sodium 50mg |
2,235 |
1,103 |
$42K |
| 91320 |
|
678 |
563 |
$42K |
| 82570 |
|
4,470 |
3,636 |
$42K |
| 71020 |
|
3,542 |
2,830 |
$41K |
| 85384 |
|
3,225 |
2,245 |
$41K |
| 86664 |
|
1,673 |
1,465 |
$41K |
| 0054A |
|
1,257 |
784 |
$40K |
| 94664 |
|
7,996 |
6,575 |
$40K |
| 90677 |
|
2,517 |
2,352 |
$39K |
| 86147 |
|
331 |
313 |
$39K |
| 87493 |
|
623 |
533 |
$39K |
| 82610 |
|
1,270 |
1,163 |
$38K |
| J0586 |
Abobotulinumtoxina |
19 |
12 |
$38K |
| 42821 |
|
81 |
67 |
$38K |
| 71555 |
|
57 |
50 |
$38K |
| 88341 |
|
240 |
182 |
$36K |
| 95713 |
|
83 |
74 |
$35K |
| 74240 |
|
890 |
810 |
$35K |
| 86663 |
|
1,674 |
1,466 |
$35K |
| 87641 |
|
963 |
733 |
$35K |
| 90656 |
|
2,199 |
1,965 |
$34K |
| 86905 |
|
603 |
428 |
$34K |
| 82009 |
|
3,577 |
3,122 |
$34K |
| 80329 |
|
1,192 |
834 |
$34K |
| 73120 |
|
1,659 |
1,218 |
$33K |
| 51726 |
|
140 |
91 |
$33K |
| 93296 |
|
1,043 |
901 |
$33K |
| 82397 |
|
1,330 |
1,221 |
$33K |
| 82024 |
|
1,027 |
915 |
$33K |
| 73000 |
|
2,107 |
1,649 |
$33K |
| J1644 |
Inj heparin sodium per 1000u |
4,288 |
491 |
$33K |
| 87015 |
|
3,788 |
2,473 |
$32K |
| 83721 |
|
1,455 |
1,360 |
$31K |
| 90732 |
|
1,302 |
806 |
$30K |
| 31622 |
|
55 |
53 |
$30K |
| 85018 |
|
6,404 |
3,934 |
$30K |
| 82139 |
|
977 |
831 |
$29K |
| 92582 |
|
4,314 |
3,854 |
$29K |
| 80164 |
|
615 |
517 |
$29K |
| J0696 |
Ceftriaxone sodium injection |
1,437 |
870 |
$29K |
| 82565 |
|
3,645 |
2,801 |
$28K |
| 70360 |
|
2,591 |
2,344 |
$28K |
| 93242 |
|
1,883 |
1,480 |
$27K |
| 0154A |
|
607 |
550 |
$27K |
| 70544 |
|
46 |
39 |
$25K |
| 84156 |
|
3,647 |
2,862 |
$25K |
| 84681 |
|
634 |
535 |
$24K |
| 29345 |
|
77 |
75 |
$24K |
| 92133 |
|
1,220 |
895 |
$24K |
| 84550 |
|
3,330 |
2,681 |
$23K |
| 92557 |
|
1,683 |
1,467 |
$23K |
| 83525 |
|
1,311 |
1,176 |
$23K |
| J1100 |
Dexamethasone sodium phos |
1,540 |
952 |
$22K |
| J3490 |
Drugs unclassified injection |
852 |
492 |
$22K |
| 80320 |
|
831 |
667 |
$21K |
| 24538 |
|
75 |
63 |
$21K |
| 93321 |
|
575 |
472 |
$21K |
| 92250 |
|
1,650 |
1,282 |
$21K |
| 86431 |
|
1,780 |
1,644 |
$20K |
| 87210 |
|
2,798 |
2,151 |
$20K |
| 84484 |
|
1,080 |
872 |
$19K |
| 91319 |
|
472 |
406 |
$19K |
| M0243 |
Casirivi and imdevi inj |
44 |
40 |
$19K |
| 91318 |
|
747 |
693 |
$19K |
| 82947 |
|
2,634 |
2,168 |
$19K |
| 75565 |
|
201 |
155 |
$19K |
| 73620 |
|
708 |
464 |
$18K |
| 92524 |
|
354 |
318 |
$18K |
| 87075 |
|
1,237 |
942 |
$18K |
| 87329 |
|
1,250 |
1,052 |
$18K |
| 87328 |
|
1,251 |
1,052 |
$18K |
| 74241 |
|
438 |
371 |
$17K |
| 92134 |
|
1,105 |
820 |
$17K |
| 87505 |
|
95 |
88 |
$17K |
| G0463 |
Hospital outpt clinic visit |
1,718 |
1,309 |
$17K |
| 88720 |
|
6,287 |
2,749 |
$17K |
| 82945 |
|
3,469 |
2,188 |
$17K |
| 80051 |
|
1,330 |
981 |
$16K |
| 86308 |
|
1,816 |
1,621 |
$16K |
| 90713 |
|
1,416 |
1,266 |
$16K |
| 93304 |
|
215 |
184 |
$16K |
| 84157 |
|
3,470 |
2,188 |
$16K |
| 84510 |
|
1,907 |
1,247 |
$16K |
| 88312 |
|
608 |
541 |
$16K |
| 71250 |
|
75 |
64 |
$16K |
| 77076 |
|
494 |
432 |
$16K |
| 74020 |
|
939 |
699 |
$15K |
| 74270 |
|
260 |
235 |
$15K |
| 86146 |
|
123 |
116 |
$15K |
| 17250 |
|
27 |
26 |
$15K |
| 92522 |
|
333 |
294 |
$14K |
| 89230 |
|
1,143 |
973 |
$14K |
| 83605 |
|
950 |
746 |
$14K |
| 84075 |
|
1,989 |
1,674 |
$14K |
| J2250 |
Inj midazolam hydrochloride |
922 |
580 |
$14K |
| 92018 |
|
49 |
39 |
$14K |
| 97003 |
|
584 |
487 |
$13K |
| J2704 |
Inj, propofol, 10 mg |
7,292 |
5,068 |
$13K |
| 86644 |
|
651 |
516 |
$13K |
| 84030 |
|
1,911 |
1,249 |
$13K |
| 92552 |
|
2,168 |
1,894 |
$13K |
| 92586 |
|
510 |
458 |
$13K |
| 84134 |
|
470 |
391 |
$13K |
| 82270 |
|
2,896 |
2,395 |
$12K |
| 73660 |
|
754 |
620 |
$12K |
| 83655 |
|
1,242 |
1,134 |
$12K |
| 90685 |
|
1,412 |
1,280 |
$12K |
| 84520 |
|
1,945 |
1,620 |
$12K |
| 90381 |
|
1,055 |
925 |
$12K |
| 92650 |
|
525 |
449 |
$12K |
| J2545 |
Pentamidine non-comp unit |
355 |
263 |
$12K |
| 84436 |
|
802 |
722 |
$12K |
| 86945 |
|
719 |
331 |
$11K |
| 86774 |
|
611 |
513 |
$11K |
| 93243 |
|
68 |
33 |
$11K |
| 92556 |
|
2,230 |
1,923 |
$11K |
| 92235 |
|
282 |
210 |
$11K |
| 94726 |
|
296 |
228 |
$10K |
| 86481 |
|
229 |
181 |
$10K |
| 75557 |
|
31 |
28 |
$10K |
| 82438 |
|
1,832 |
858 |
$10K |
| 54163 |
|
43 |
43 |
$10K |
| 89051 |
|
1,273 |
916 |
$10K |
| 86645 |
|
438 |
363 |
$10K |
| 85240 |
|
472 |
377 |
$10K |
| J1815 |
Insulin injection |
59 |
41 |
$10K |
| 76506 |
|
643 |
542 |
$9K |
| 84132 |
|
1,456 |
1,110 |
$9K |
| 93597 |
|
45 |
24 |
$9K |
| 86648 |
|
475 |
402 |
$9K |
| 90380 |
|
975 |
695 |
$9K |
| 84702 |
|
540 |
442 |
$9K |
| 85246 |
|
295 |
241 |
$9K |
| 86231 |
|
513 |
481 |
$8K |
| 76010 |
|
1,006 |
902 |
$8K |
| 74000 |
|
656 |
517 |
$8K |
| 92555 |
|
2,599 |
2,320 |
$8K |
| 86353 |
|
68 |
52 |
$8K |
| 84155 |
|
1,396 |
1,028 |
$8K |
| 72110 |
|
141 |
131 |
$8K |
| 81243 |
|
204 |
153 |
$8K |
| 85014 |
|
2,157 |
1,406 |
$8K |
| 87181 |
|
409 |
326 |
$7K |
| 89050 |
|
1,638 |
999 |
$7K |
| 53450 |
|
13 |
12 |
$7K |
| 86704 |
|
383 |
290 |
$7K |
| 85379 |
|
431 |
352 |
$7K |
| 95811 |
|
47 |
36 |
$7K |
| 99401 |
|
1,119 |
686 |
$7K |
| 73600 |
|
192 |
155 |
$6K |
| 49500 |
|
24 |
24 |
$6K |
| 95715 |
|
22 |
15 |
$6K |
| 84481 |
|
122 |
112 |
$6K |
| J1200 |
Diphenhydramine hcl injectio |
1,909 |
1,087 |
$6K |
| 76937 |
|
271 |
223 |
$6K |
| 95012 |
|
3,466 |
3,231 |
$6K |
| 93308 |
|
96 |
81 |
$5K |
| 30130 |
|
12 |
12 |
$5K |
| 92585 |
|
201 |
157 |
$5K |
| 0083A |
|
135 |
131 |
$5K |
| 85347 |
|
758 |
117 |
$5K |
| 76499 |
|
246 |
120 |
$5K |
| 76000 |
|
2,985 |
2,513 |
$5K |
| 0202U |
|
638 |
548 |
$5K |
| 84403 |
|
185 |
156 |
$5K |
| 86832 |
|
90 |
64 |
$4K |
| 82746 |
|
133 |
116 |
$4K |
| J3010 |
Fentanyl citrate injection |
2,366 |
1,416 |
$4K |
| 92553 |
|
483 |
397 |
$4K |
| 75573 |
|
30 |
25 |
$4K |
| 82310 |
|
460 |
367 |
$4K |
| 90471 |
|
856 |
592 |
$4K |
| 80195 |
|
179 |
117 |
$4K |
| 97165 |
|
29 |
27 |
$4K |
| 93270 |
|
72 |
61 |
$4K |
| 72080 |
|
152 |
123 |
$3K |
| 90744 |
|
337 |
292 |
$3K |
| 82670 |
|
121 |
110 |
$3K |
| 94760 |
|
308 |
239 |
$3K |
| 83021 |
|
134 |
119 |
$3K |
| 0003A |
|
64 |
62 |
$3K |
| 83498 |
|
107 |
92 |
$3K |
| 82340 |
|
259 |
241 |
$3K |
| 85670 |
|
263 |
230 |
$3K |
| 86985 |
|
464 |
325 |
$3K |
| J1642 |
Inj heparin sodium per 10 u |
3,973 |
1,389 |
$3K |
| 87807 |
|
209 |
189 |
$2K |
| 86833 |
|
92 |
66 |
$2K |
| 76604 |
|
80 |
65 |
$2K |
| 84466 |
|
108 |
92 |
$2K |
| 84295 |
|
379 |
253 |
$2K |
| 86060 |
|
183 |
153 |
$2K |
| 92583 |
|
712 |
632 |
$2K |
| D1351 |
|
85 |
26 |
$2K |
| D0120 |
|
321 |
279 |
$2K |
| 92083 |
|
569 |
461 |
$2K |
| 95822 |
|
18 |
12 |
$2K |
| 87110 |
|
63 |
59 |
$2K |
| 90472 |
|
230 |
155 |
$2K |
| Q3014 |
Telehealth facility fee |
399 |
384 |
$2K |
| 82140 |
|
104 |
88 |
$2K |
| 92273 |
|
16 |
13 |
$2K |
| 83520 |
|
242 |
169 |
$2K |
| 81479 |
|
69 |
32 |
$2K |
| 86592 |
|
244 |
222 |
$1K |
| 85245 |
|
39 |
27 |
$1K |
| D1208 |
|
101 |
82 |
$1K |
| 84311 |
|
212 |
179 |
$1K |
| 92595 |
|
758 |
690 |
$1K |
| 85335 |
|
71 |
67 |
$1K |
| 45380 |
|
39 |
35 |
$1K |
| 87116 |
|
122 |
75 |
$1K |
| 71010 |
|
228 |
158 |
$1K |
| 88313 |
|
39 |
29 |
$1K |
| 82374 |
|
237 |
153 |
$1K |
| D1110 |
|
157 |
136 |
$1K |
| J1720 |
Hydrocortisone sodium succ i |
342 |
235 |
$1K |
| 86708 |
|
63 |
53 |
$1K |
| 89055 |
|
198 |
160 |
$1K |
| 94640 |
|
274 |
183 |
$997.80 |
| 87101 |
|
126 |
108 |
$994.52 |
| 87102 |
|
94 |
75 |
$976.92 |
| 72050 |
|
12 |
12 |
$935.83 |
| 88311 |
|
43 |
38 |
$912.26 |
| 93280 |
|
16 |
13 |
$888.60 |
| 93971 |
|
15 |
12 |
$876.00 |
| 86235 |
|
101 |
88 |
$799.52 |
| 92591 |
|
163 |
150 |
$784.62 |
| 73092 |
|
34 |
26 |
$773.92 |
| 84478 |
|
69 |
50 |
$752.87 |
| 16020 |
|
35 |
29 |
$734.41 |
| 74455 |
|
283 |
246 |
$730.83 |
| 82627 |
|
30 |
25 |
$720.02 |
| 84402 |
|
34 |
27 |
$690.84 |
| 87635 |
|
16 |
12 |
$688.59 |
| 86787 |
|
41 |
40 |
$679.14 |
| J0834 |
Inj., cosyntropin, 0.25 mg |
13 |
12 |
$672.94 |
| 86940 |
|
72 |
52 |
$668.00 |
| 84244 |
|
27 |
25 |
$659.61 |
| 87498 |
|
22 |
13 |
$658.71 |
| 90999 |
|
340 |
12 |
$620.00 |
| 87653 |
|
21 |
13 |
$608.04 |
| 87532 |
|
21 |
13 |
$601.44 |
| 87496 |
|
21 |
13 |
$601.44 |
| 87425 |
|
53 |
45 |
$595.53 |
| 84210 |
|
45 |
40 |
$589.38 |
| 87206 |
|
118 |
74 |
$587.06 |
| 85250 |
|
13 |
12 |
$553.59 |
| 86038 |
|
179 |
151 |
$517.33 |
| 86039 |
|
169 |
152 |
$507.90 |
| 90630 |
|
24 |
23 |
$496.63 |
| 88350 |
|
25 |
16 |
$446.82 |
| J1885 |
Ketorolac tromethamine inj |
45 |
29 |
$437.51 |
| 99402 |
|
23 |
18 |
$429.00 |
| 90672 |
|
18 |
18 |
$417.96 |
| 92551 |
|
99 |
87 |
$374.47 |
| 86880 |
|
30 |
28 |
$319.84 |
| 83090 |
|
13 |
13 |
$313.17 |
| 86225 |
|
94 |
79 |
$264.68 |
| 84446 |
|
82 |
67 |
$253.75 |
| V5275 |
Ear impression |
156 |
151 |
$245.50 |
| 84590 |
|
76 |
60 |
$213.64 |
| 80158 |
|
19 |
13 |
$193.22 |
| 87147 |
|
34 |
26 |
$192.14 |
| 82085 |
|
58 |
46 |
$152.57 |
| J0702 |
Betamethasone acet&sod phosp |
13 |
12 |
$151.97 |
| 96374 |
|
15 |
12 |
$142.73 |
| 92593 |
|
104 |
85 |
$142.21 |
| 90649 |
|
16 |
14 |
$133.84 |
| 88346 |
|
25 |
16 |
$127.38 |
| A9539 |
Tc99m pentetate |
23 |
12 |
$123.12 |
| 83935 |
|
17 |
13 |
$116.76 |
| 82542 |
|
13 |
12 |
$109.13 |
| 92558 |
|
1,795 |
1,598 |
$104.16 |
| 92594 |
|
389 |
356 |
$99.02 |
| 87209 |
|
15 |
12 |
$94.92 |
| 82465 |
|
19 |
13 |
$80.86 |
| 82379 |
|
25 |
12 |
$79.28 |
| 94799 |
|
39 |
27 |
$71.60 |
| 86317 |
|
35 |
30 |
$65.64 |
| 87522 |
Neg quan hep c or qual rna |
25 |
20 |
$51.17 |
| 99214 |
|
157 |
147 |
$43.50 |
| 99213 |
|
184 |
177 |
$43.50 |
| 85008 |
|
85 |
56 |
$41.54 |
| 87177 |
|
15 |
12 |
$38.13 |
| 87338 |
|
32 |
26 |
$31.69 |
| J2919 |
Inj, methylpred sod succ 5mg |
20 |
13 |
$25.91 |
| 96112 |
|
738 |
686 |
$24.11 |
| J2001 |
Lidocaine injection |
66 |
43 |
$8.77 |
| 76001 |
|
95 |
56 |
$0.00 |
| D0330 |
|
20 |
16 |
$0.00 |
| 93319 |
|
174 |
147 |
$0.00 |
| A9999 |
Dme supply or accessory, nos |
234 |
179 |
$0.00 |
| D2391 |
|
44 |
41 |
$0.00 |
| 80301 |
|
242 |
191 |
$0.00 |
| A6250 |
Skin seal protect moisturizr |
54 |
41 |
$0.00 |
| 99215 |
Prolong outpt/office vis |
13 |
13 |
$0.00 |
| A4550 |
Surgical trays |
273 |
192 |
$0.00 |
| A7046 |
Repl water chamber, pap dev |
348 |
325 |
$0.00 |
| A4245 |
Alcohol wipes per box |
13 |
13 |
$0.00 |
| 76981 |
|
50 |
41 |
$0.00 |
| 99392 |
|
16 |
12 |
$0.00 |
| 92622 |
|
37 |
36 |
$0.00 |
| D0220 |
|
46 |
40 |
$0.00 |
| A7003 |
Nebulizer administration set |
12 |
12 |
$0.00 |
| 99204 |
|
21 |
21 |
$0.00 |
| D8690 |
|
33 |
29 |
$0.00 |
| D2930 |
|
42 |
39 |
$0.00 |
| A4663 |
Dialysis blood pressure cuff |
72 |
69 |
$0.00 |
| D1120 |
|
149 |
132 |
$0.00 |
| J7120 |
Ringers lactate infusion |
25 |
22 |
$0.00 |
| 51784 |
|
14 |
13 |
$0.00 |
| D0274 |
|
44 |
40 |
$0.00 |
| 92592 |
|
14 |
13 |
$0.00 |
| 99391 |
|
42 |
36 |
$0.00 |
| D2392 |
|
20 |
18 |
$0.00 |
| A4461 |
Surgicl dress hold non-reuse |
296 |
213 |
$0.00 |
| 96372 |
|
21 |
20 |
$0.00 |
| 92228 |
|
200 |
193 |
$0.00 |
| D3220 |
|
35 |
32 |
$0.00 |
| 80304 |
|
46 |
46 |
$0.00 |
| E1399 |
Durable medical equipment mi |
556 |
379 |
$0.00 |
| 92590 |
|
47 |
42 |
$0.00 |
| B4088 |
Gastro/jejuno tube, low-pro |
459 |
414 |
$0.00 |
| A6222 |
Gauze <=16 in no w/sal w/o b |
125 |
75 |
$0.00 |
| A4215 |
Sterile needle |
135 |
103 |
$0.00 |
| A9276 |
Disposable sensor, cgm sys |
263 |
241 |
$0.00 |
| J7060 |
5% dextrose/water |
47 |
20 |
$0.00 |
| J7050 |
Normal saline solution infus |
463 |
348 |
$0.00 |
| D0140 |
|
139 |
129 |
$0.00 |
| 99381 |
|
130 |
99 |
$0.00 |
| D1206 |
|
201 |
181 |
$0.00 |
| D7140 |
|
38 |
36 |
$0.00 |
| D0230 |
|
37 |
34 |
$0.00 |
| 86769 |
|
55 |
50 |
$0.00 |
| D2330 |
|
18 |
16 |
$0.00 |
| 93246 |
|
14 |
13 |
$0.00 |
| E0602 |
Manual breast pump |
28 |
15 |
$0.00 |
| J7042 |
5% dextrose/normal saline |
60 |
47 |
$0.00 |
| D0150 |
|
23 |
21 |
$0.00 |
| D2335 |
|
16 |
14 |
$0.00 |
| A7015 |
Aerosol mask used w nebulize |
12 |
12 |
$0.00 |