| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 0450 |
|
16,745 |
14,856 |
$1.58M |
| A4649 |
Surgical supplies |
4,019 |
3,450 |
$1.57M |
| J3490 |
Drugs unclassified injection |
5,704 |
4,255 |
$862K |
| 36415 |
|
5,008 |
4,377 |
$595K |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
927 |
908 |
$231K |
| 80053 |
|
6,639 |
5,913 |
$193K |
| 71046 |
|
1,734 |
1,707 |
$95K |
| J1885 |
Ketorolac tromethamine inj |
790 |
739 |
$90K |
| 87081 |
|
723 |
716 |
$83K |
| 87502 |
|
896 |
887 |
$67K |
| J1100 |
Dexamethasone sodium phos |
408 |
397 |
$66K |
| G0480 |
Drug test def 1-7 classes |
1,323 |
1,030 |
$64K |
| J7030 |
Normal saline solution infus |
1,568 |
1,401 |
$46K |
| J2270 |
Morphine sulfate injection |
590 |
518 |
$46K |
| J2405 |
Ondansetron hcl injection |
1,051 |
956 |
$42K |
| 11042 |
|
474 |
219 |
$39K |
| 70450 |
|
952 |
924 |
$39K |
| 71045 |
|
2,071 |
1,991 |
$39K |
| 74177 |
|
725 |
711 |
$37K |
| 81001 |
|
3,148 |
2,976 |
$33K |
| 87086 |
|
1,542 |
1,487 |
$33K |
| 87804 |
|
477 |
469 |
$30K |
| 96374 |
|
1,790 |
1,635 |
$27K |
| J0696 |
Ceftriaxone sodium injection |
168 |
163 |
$26K |
| J2060 |
Lorazepam injection |
241 |
217 |
$23K |
| 80048 |
|
986 |
944 |
$23K |
| 87635 |
|
450 |
427 |
$21K |
| J1200 |
Diphenhydramine hcl injectio |
165 |
153 |
$19K |
| J1170 |
Hydromorphone injection |
244 |
200 |
$18K |
| 87077 |
|
346 |
341 |
$17K |
| 73630 |
|
194 |
191 |
$17K |
| 74176 |
|
678 |
670 |
$15K |
| 81002 |
|
737 |
710 |
$15K |
| 81025 |
|
1,306 |
1,263 |
$15K |
| 99283 |
|
400 |
370 |
$13K |
| 82962 |
|
833 |
444 |
$13K |
| 96365 |
|
707 |
649 |
$12K |
| 99284 |
|
483 |
450 |
$11K |
| 81000 |
|
651 |
643 |
$10K |
| 11043 |
|
49 |
25 |
$9K |
| 80307 |
|
1,246 |
1,131 |
$8K |
| 73562 |
|
94 |
93 |
$8K |
| 73130 |
|
67 |
67 |
$8K |
| 96372 |
|
1,492 |
1,370 |
$8K |
| 85025 |
|
7,347 |
6,395 |
$7K |
| 73030 |
|
73 |
71 |
$6K |
| 93005 |
|
3,401 |
3,129 |
$6K |
| 94640 |
|
754 |
667 |
$6K |
| 99285 |
|
315 |
292 |
$6K |
| 73610 |
|
62 |
61 |
$4K |
| 76705 |
|
493 |
482 |
$4K |
| 86850 |
|
95 |
95 |
$4K |
| 87880 |
|
742 |
735 |
$4K |
| 96375 |
|
1,622 |
1,428 |
$4K |
| 0710 |
|
77 |
75 |
$3K |
| J2765 |
Metoclopramide hcl injection |
102 |
92 |
$3K |
| 76856 |
|
148 |
147 |
$3K |
| 73110 |
|
40 |
40 |
$3K |
| J0131 |
Inj, acetaminophen (nos) |
151 |
146 |
$3K |
| J0780 |
Prochlorperazine injection |
13 |
13 |
$3K |
| 90715 |
|
12 |
12 |
$2K |
| U0002 |
Covid-19 lab test non-cdc |
35 |
35 |
$2K |
| 76830 |
|
80 |
80 |
$2K |
| 84702 |
|
643 |
617 |
$2K |
| 86900 |
|
198 |
196 |
$2K |
| 83880 |
|
1,068 |
993 |
$2K |
| 72100 |
|
13 |
13 |
$1K |
| 72125 |
|
16 |
16 |
$1K |
| 84703 |
|
898 |
861 |
$1K |
| 76700 |
|
12 |
12 |
$1K |
| 0761 |
|
29 |
25 |
$1K |
| 0250 |
|
14 |
12 |
$1K |
| 87070 |
|
27 |
27 |
$1K |
| 83690 |
|
3,130 |
2,875 |
$1K |
| 84443 |
|
337 |
327 |
$990.35 |
| 84484 |
|
1,916 |
1,722 |
$984.87 |
| 85610 |
|
932 |
881 |
$849.53 |
| 85379 |
|
303 |
295 |
$820.79 |
| 83605 |
|
817 |
761 |
$736.87 |
| 87186 |
|
298 |
294 |
$631.67 |
| A9270 |
Non-covered item or service |
598 |
487 |
$530.00 |
| 87491 |
|
13 |
13 |
$518.13 |
| 87634 |
|
269 |
265 |
$493.58 |
| 90471 |
|
82 |
82 |
$451.07 |
| 85730 |
|
702 |
670 |
$422.74 |
| 87040 |
|
549 |
521 |
$378.29 |
| J3010 |
Fentanyl citrate injection |
12 |
12 |
$337.68 |
| 96361 |
|
94 |
88 |
$280.93 |
| 96376 |
|
333 |
275 |
$275.40 |
| 83735 |
|
338 |
289 |
$161.40 |
| 82550 |
|
685 |
676 |
$137.33 |
| 87591 |
|
13 |
13 |
$87.97 |
| 86703 |
|
105 |
102 |
$84.57 |
| 85027 |
|
173 |
162 |
$84.31 |
| 86140 |
|
57 |
57 |
$80.38 |
| 87205 |
|
37 |
36 |
$60.44 |
| 86901 |
|
199 |
197 |
$29.03 |
| 94760 |
|
37 |
27 |
$20.43 |
| 80076 |
|
27 |
27 |
$7.32 |
| 85007 |
|
75 |
68 |
$7.12 |
| 82553 |
|
12 |
12 |
$0.00 |
| 87807 |
|
14 |
14 |
$0.00 |
| 83036 |
|
12 |
12 |
$0.00 |
| 96360 |
|
12 |
12 |
$0.00 |