| Code | Description | Claims | Beneficiaries | Total Paid |
| G0463 |
Hospital outpt clinic visit |
446,263 |
382,701 |
$21.74M |
| 99283 |
|
141,163 |
135,852 |
$6.22M |
| 99284 |
|
56,807 |
54,074 |
$4.40M |
| J1745 |
Infliximab not biosimil 10mg |
1,975 |
1,552 |
$3.61M |
| 69436 |
|
23,890 |
11,169 |
$3.26M |
| 99285 |
|
7,681 |
7,374 |
$2.48M |
| D9420 |
|
5,987 |
5,423 |
$1.57M |
| 42820 |
|
3,897 |
3,517 |
$1.55M |
| G0330 |
Facility svs dental rehab |
1,411 |
1,389 |
$1.36M |
| 99282 |
|
18,114 |
17,338 |
$733K |
| 42830 |
|
2,003 |
1,863 |
$646K |
| 80053 |
|
46,563 |
40,409 |
$585K |
| 85025 |
|
59,179 |
49,741 |
$578K |
| 95782 |
|
898 |
790 |
$561K |
| 43239 |
|
2,370 |
1,870 |
$534K |
| 92567 |
|
32,751 |
30,667 |
$454K |
| 81229 |
|
428 |
395 |
$387K |
| 76770 |
|
9,422 |
9,046 |
$385K |
| 85055 |
|
14,928 |
12,671 |
$383K |
| 83036 |
|
25,650 |
24,503 |
$373K |
| 70553 |
|
731 |
642 |
$365K |
| 87635 |
|
7,156 |
6,808 |
$311K |
| 87633 |
|
1,290 |
1,246 |
$305K |
| 95810 |
|
999 |
940 |
$276K |
| 17110 |
|
1,954 |
1,235 |
$271K |
| 36430 |
|
2,051 |
1,708 |
$260K |
| 84443 |
|
12,533 |
11,976 |
$229K |
| 96413 |
|
2,426 |
2,144 |
$218K |
| 92579 |
|
9,535 |
8,989 |
$181K |
| 87804 |
|
15,202 |
7,373 |
$176K |
| 97110 |
|
4,986 |
2,343 |
$176K |
| 83021 |
|
10,371 |
7,112 |
$167K |
| 94375 |
|
12,583 |
9,730 |
$160K |
| 86003 |
|
1,249 |
932 |
$147K |
| 86922 |
|
3,871 |
2,563 |
$145K |
| Q3014 |
Telehealth facility fee |
7,884 |
7,640 |
$141K |
| 84439 |
|
13,936 |
13,141 |
$139K |
| 92555 |
|
11,176 |
10,571 |
$134K |
| 80061 |
|
6,989 |
6,691 |
$119K |
| 67311 |
|
513 |
259 |
$101K |
| 93306 |
|
791 |
642 |
$81K |
| 71046 |
|
6,602 |
6,354 |
$80K |
| 85046 |
|
15,377 |
13,050 |
$79K |
| 92582 |
|
2,285 |
2,166 |
$78K |
| 82784 |
|
4,435 |
4,022 |
$74K |
| 80069 |
|
9,159 |
8,306 |
$73K |
| 81479 |
|
50 |
50 |
$72K |
| 83721 |
|
7,968 |
7,585 |
$70K |
| 92611 |
|
2,354 |
1,801 |
$64K |
| 70551 |
|
311 |
291 |
$63K |
| 82977 |
|
9,109 |
7,821 |
$63K |
| 87497 |
|
1,761 |
1,451 |
$59K |
| 83970 |
|
991 |
920 |
$59K |
| 54161 |
|
258 |
223 |
$56K |
| 97530 |
|
2,004 |
901 |
$55K |
| 82728 |
|
5,442 |
4,428 |
$51K |
| 43762 |
|
248 |
230 |
$50K |
| 95004 |
|
2,784 |
2,146 |
$49K |
| 82570 |
|
7,754 |
7,102 |
$49K |
| 92526 |
|
989 |
858 |
$44K |
| G0410 |
Grp psych php/iop 45-50 |
201 |
24 |
$43K |
| 96374 |
|
2,012 |
1,642 |
$41K |
| 85652 |
|
11,192 |
9,810 |
$41K |
| 83516 |
|
2,557 |
2,462 |
$41K |
| 87651 |
|
999 |
972 |
$40K |
| 83880 |
|
1,315 |
1,039 |
$40K |
| 87491 |
|
1,138 |
1,066 |
$39K |
| 80306 |
|
2,688 |
2,516 |
$38K |
| 95819 |
|
190 |
185 |
$38K |
| 87070 |
|
3,400 |
3,100 |
$37K |
| 74230 |
|
2,427 |
1,870 |
$37K |
| 81003 |
|
11,045 |
10,620 |
$36K |
| 95811 |
|
106 |
97 |
$35K |
| 86255 |
|
1,498 |
1,227 |
$34K |
| 87880 |
|
2,214 |
2,161 |
$34K |
| 92552 |
|
2,012 |
1,927 |
$33K |
| 82306 |
|
3,571 |
3,366 |
$33K |
| 82785 |
|
1,886 |
1,442 |
$30K |
| 92524 |
|
778 |
694 |
$30K |
| 83735 |
|
4,430 |
3,576 |
$30K |
| 82248 |
|
6,150 |
5,069 |
$28K |
| 72082 |
|
1,708 |
1,660 |
$27K |
| 70355 |
|
1,250 |
1,208 |
$25K |
| 94664 |
|
4,916 |
4,009 |
$25K |
| 86140 |
|
11,646 |
10,229 |
$24K |
| 74018 |
|
2,138 |
2,031 |
$23K |
| 73090 |
|
1,678 |
1,380 |
$22K |
| 87661 |
|
1,110 |
1,044 |
$22K |
| 81001 |
|
5,090 |
4,552 |
$21K |
| 73562 |
|
758 |
721 |
$20K |
| 88185 |
|
247 |
197 |
$20K |
| 86850 |
|
3,397 |
2,703 |
$19K |
| 86945 |
|
661 |
518 |
$19K |
| 80076 |
|
2,107 |
1,897 |
$18K |
| 93005 |
|
1,176 |
1,029 |
$17K |
| 80197 |
|
2,071 |
1,489 |
$17K |
| 92587 |
|
1,252 |
1,214 |
$17K |
| 93976 |
|
212 |
197 |
$16K |
| 90686 |
|
1,089 |
1,000 |
$16K |
| 77077 |
|
571 |
549 |
$16K |
| 84156 |
|
4,024 |
3,655 |
$16K |
| 96415 |
|
714 |
606 |
$15K |
| 70360 |
|
1,390 |
1,317 |
$15K |
| 83550 |
|
1,183 |
998 |
$14K |
| 82043 |
|
2,713 |
2,586 |
$14K |
| 84703 |
|
2,052 |
1,938 |
$13K |
| 87798 |
|
394 |
195 |
$13K |
| 83615 |
|
2,108 |
1,833 |
$12K |
| 74019 |
|
812 |
782 |
$12K |
| 73630 |
|
776 |
494 |
$12K |
| 86905 |
|
2,298 |
1,542 |
$12K |
| 82803 |
|
378 |
331 |
$11K |
| 29075 |
|
294 |
239 |
$10K |
| 84100 |
|
2,702 |
2,124 |
$10K |
| 97112 |
|
479 |
193 |
$10K |
| 85610 |
|
1,982 |
1,570 |
$10K |
| 72020 |
|
340 |
331 |
$10K |
| 86235 |
|
193 |
186 |
$10K |
| 86902 |
|
2,967 |
1,992 |
$10K |
| 96409 |
|
138 |
101 |
$10K |
| 80050 |
|
212 |
132 |
$9K |
| 86364 |
|
1,384 |
1,206 |
$9K |
| 83540 |
|
1,220 |
1,032 |
$9K |
| 86900 |
|
3,445 |
2,758 |
$9K |
| 86901 |
|
3,447 |
2,759 |
$9K |
| 87086 |
|
940 |
877 |
$8K |
| 80074 |
|
201 |
131 |
$8K |
| 82652 |
|
154 |
145 |
$8K |
| 95816 |
|
176 |
168 |
$8K |
| 96401 |
|
227 |
195 |
$7K |
| 86038 |
|
412 |
373 |
$7K |
| 88230 |
|
46 |
42 |
$7K |
| 82947 |
|
1,216 |
1,123 |
$7K |
| 72081 |
|
451 |
423 |
$7K |
| 72170 |
|
494 |
474 |
$7K |
| 88184 |
|
247 |
197 |
$6K |
| 82550 |
|
884 |
642 |
$6K |
| 86317 |
|
159 |
123 |
$6K |
| 94640 |
|
1,700 |
1,628 |
$6K |
| 73560 |
|
402 |
323 |
$6K |
| J7120 |
Ringers lactate infusion |
12,700 |
11,621 |
$6K |
| 87077 |
|
810 |
507 |
$6K |
| 73130 |
|
445 |
319 |
$6K |
| 80051 |
|
689 |
657 |
$6K |
| 83690 |
|
690 |
666 |
$5K |
| 84550 |
|
917 |
811 |
$5K |
| 86225 |
|
342 |
315 |
$5K |
| 88262 |
|
34 |
30 |
$5K |
| J1100 |
Dexamethasone sodium phos |
14,771 |
9,950 |
$5K |
| 82150 |
|
610 |
590 |
$5K |
| 31575 |
|
16 |
16 |
$5K |
| 97161 |
|
91 |
88 |
$4K |
| 73140 |
|
443 |
291 |
$4K |
| 82465 |
|
630 |
527 |
$4K |
| 83655 |
|
284 |
261 |
$4K |
| 73070 |
|
323 |
267 |
$4K |
| 96375 |
|
162 |
103 |
$4K |
| 83718 |
|
630 |
527 |
$4K |
| 97016 |
|
230 |
63 |
$4K |
| 45380 |
|
27 |
14 |
$3K |
| 96365 |
|
90 |
77 |
$3K |
| 83520 |
|
143 |
137 |
$3K |
| 85014 |
|
1,101 |
1,044 |
$3K |
| 86376 |
|
171 |
154 |
$3K |
| 82390 |
|
342 |
254 |
$3K |
| 82085 |
|
253 |
208 |
$3K |
| 73100 |
|
228 |
193 |
$3K |
| 82088 |
|
69 |
62 |
$3K |
| J3010 |
Fentanyl citrate injection |
17,148 |
11,842 |
$3K |
| 93888 |
|
40 |
37 |
$3K |
| 30802 |
|
16 |
13 |
$3K |
| 70450 |
|
26 |
25 |
$3K |
| 86481 |
|
34 |
32 |
$3K |
| 83525 |
|
251 |
241 |
$2K |
| J1885 |
Ketorolac tromethamine inj |
5,915 |
3,263 |
$2K |
| 82103 |
|
255 |
179 |
$2K |
| 91065 |
|
60 |
42 |
$2K |
| 95117 |
|
200 |
101 |
$2K |
| 86162 |
|
111 |
107 |
$2K |
| 82104 |
|
143 |
131 |
$2K |
| 97760 |
|
104 |
78 |
$2K |
| 77072 |
|
243 |
237 |
$2K |
| 83519 |
|
199 |
184 |
$2K |
| 43760 |
|
15 |
12 |
$2K |
| 71045 |
|
394 |
332 |
$2K |
| 64642 |
|
15 |
12 |
$2K |
| 95812 |
|
62 |
58 |
$2K |
| 91200 |
|
14 |
14 |
$2K |
| 86706 |
|
115 |
97 |
$2K |
| 73610 |
|
115 |
105 |
$2K |
| 83001 |
|
67 |
66 |
$2K |
| 85027 |
|
381 |
283 |
$2K |
| 83002 |
|
71 |
67 |
$2K |
| J2704 |
Inj, propofol, 10 mg |
10,351 |
9,452 |
$2K |
| 73590 |
|
105 |
89 |
$2K |
| 86160 |
|
45 |
39 |
$2K |
| 82670 |
|
53 |
51 |
$1K |
| 85007 |
|
378 |
281 |
$1K |
| 80180 |
|
121 |
96 |
$1K |
| 92553 |
|
109 |
106 |
$1K |
| 84244 |
|
56 |
50 |
$1K |
| 87591 |
|
33 |
28 |
$1K |
| 87186 |
|
110 |
98 |
$1K |
| 99281 |
|
21 |
21 |
$1K |
| 86708 |
|
90 |
50 |
$1K |
| 82105 |
|
55 |
50 |
$968.44 |
| 86341 |
|
51 |
50 |
$921.67 |
| 73552 |
|
64 |
52 |
$911.68 |
| 85730 |
|
338 |
314 |
$878.92 |
| 76700 |
|
26 |
26 |
$876.36 |
| 82610 |
|
57 |
52 |
$867.15 |
| J7050 |
Normal saline solution infus |
1,678 |
1,353 |
$829.45 |
| 86774 |
|
40 |
39 |
$828.78 |
| 86360 |
|
13 |
13 |
$793.87 |
| 86231 |
|
92 |
92 |
$769.86 |
| J2405 |
Ondansetron hcl injection |
10,280 |
9,202 |
$745.74 |
| 82525 |
|
58 |
58 |
$712.85 |
| 92610 |
|
40 |
12 |
$691.44 |
| 94200 |
|
84 |
81 |
$691.29 |
| 97162 |
|
16 |
15 |
$652.20 |
| 96366 |
|
40 |
35 |
$646.00 |
| 82533 |
|
26 |
24 |
$632.94 |
| J1200 |
Diphenhydramine hcl injectio |
1,131 |
869 |
$630.53 |
| 73564 |
|
24 |
24 |
$595.68 |
| 82139 |
|
29 |
27 |
$593.06 |
| 82607 |
|
44 |
27 |
$572.01 |
| J9370 |
Vincristine sulfate 1 mg inj |
79 |
53 |
$559.23 |
| J1596 |
Inj, glycopyrrolate, 0.1 mg |
2,524 |
1,398 |
$535.50 |
| 84403 |
|
14 |
14 |
$515.10 |
| 84630 |
|
29 |
29 |
$455.00 |
| 0002A |
|
13 |
12 |
$440.00 |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
68 |
66 |
$423.01 |
| 86039 |
|
28 |
25 |
$411.25 |
| 85347 |
|
176 |
24 |
$375.04 |
| 87389 |
|
13 |
13 |
$367.51 |
| 82330 |
|
81 |
63 |
$364.86 |
| 85018 |
|
142 |
136 |
$364.01 |
| 83921 |
|
18 |
15 |
$332.08 |
| 84305 |
|
27 |
27 |
$310.04 |
| 83090 |
|
25 |
14 |
$308.36 |
| 82747 |
|
25 |
14 |
$308.36 |
| A9585 |
Gadobutrol injection |
1,143 |
1,001 |
$303.61 |
| 74240 |
|
13 |
12 |
$288.18 |
| 86406 |
|
24 |
12 |
$280.93 |
| 85379 |
|
26 |
26 |
$280.75 |
| 77073 |
|
12 |
12 |
$277.31 |
| 96372 |
|
56 |
27 |
$270.00 |
| 74455 |
|
12 |
12 |
$256.95 |
| 73521 |
|
14 |
13 |
$224.38 |
| 84446 |
|
14 |
12 |
$222.12 |
| J2930 |
Methylprednisolone injection |
20 |
12 |
$220.11 |
| 86923 |
|
33 |
12 |
$217.98 |
| 70350 |
|
13 |
13 |
$211.90 |
| 84132 |
|
44 |
39 |
$207.51 |
| 84295 |
|
44 |
39 |
$200.79 |
| 82565 |
|
44 |
39 |
$200.79 |
| 86592 |
|
29 |
28 |
$192.00 |
| J0690 |
Cefazolin sodium injection |
314 |
284 |
$176.05 |
| 82435 |
|
44 |
39 |
$167.04 |
| 84590 |
|
13 |
12 |
$141.96 |
| 84484 |
|
12 |
12 |
$134.76 |
| 85384 |
|
12 |
12 |
$134.52 |
| 83605 |
|
13 |
12 |
$133.20 |
| J2175 |
Meperidine hydrochl /100 mg |
28 |
26 |
$77.87 |
| J1644 |
Inj heparin sodium per 1000u |
82 |
63 |
$58.30 |
| J2250 |
Inj midazolam hydrochloride |
86 |
83 |
$53.51 |
| J1642 |
Inj heparin sodium per 10 u |
90 |
65 |
$42.70 |
| 88305 |
|
932 |
632 |
$33.90 |
| J0665 |
Inj, bupivacaine, nos, 0.5mg |
182 |
162 |
$1.30 |
| Q0162 |
Ondansetron oral |
1,229 |
1,189 |
$0.78 |
| 82657 |
|
685 |
314 |
$0.00 |
| G0008 |
Admin influenza virus vac |
126 |
120 |
$0.00 |
| J7613 |
Albuterol non-comp unit |
592 |
562 |
$0.00 |
| 95012 |
|
446 |
416 |
$0.00 |
| 11900 |
|
118 |
78 |
$0.00 |
| 90471 |
|
379 |
356 |
$0.00 |
| J2795 |
Ropivacaine hcl injection |
204 |
193 |
$0.00 |
| 92593 |
|
98 |
97 |
$0.00 |
| 87046 |
|
25 |
14 |
$0.00 |
| J7644 |
Ipratropium bromide non-comp |
13 |
12 |
$0.00 |
| 87493 |
|
25 |
14 |
$0.00 |
| B4087 |
Gastro/jejuno tube, std |
83 |
52 |
$0.00 |
| 80230 |
|
37 |
37 |
$0.00 |
| 81332 |
|
12 |
12 |
$0.00 |
| 87209 |
|
23 |
14 |
$0.00 |
| 87328 |
|
327 |
173 |
$0.00 |
| 87799 |
|
1,656 |
1,331 |
$0.00 |
| J2270 |
Morphine sulfate injection |
24 |
24 |
$0.00 |
| 92557 |
|
39 |
39 |
$0.00 |
| 92592 |
|
12 |
12 |
$0.00 |
| 87329 |
|
521 |
258 |
$0.00 |
| Q0163 |
Diphenhydramine hcl 50mg |
47 |
39 |
$0.00 |
| 86008 |
|
157 |
92 |
$0.00 |
| 87045 |
|
25 |
14 |
$0.00 |
| 87177 |
|
23 |
14 |
$0.00 |
| 87899 |
|
50 |
14 |
$0.00 |
| Q9958 |
Hocm <=149 mg/ml iodine, 1ml |
37 |
37 |
$0.00 |
| 84460 |
|
14 |
14 |
$0.00 |
| 84450 |
|
14 |
14 |
$0.00 |
| 87327 |
|
156 |
63 |
$0.00 |
| 89055 |
|
25 |
14 |
$0.00 |