| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 0450 |
|
19,155 |
17,109 |
$781K |
| 0915 |
|
1,532 |
134 |
$319K |
| 80307 |
|
6,463 |
5,983 |
$266K |
| 70450 |
|
2,033 |
1,964 |
$159K |
| G0480 |
Drug test def 1-7 classes |
2,949 |
2,681 |
$128K |
| 0360 |
|
815 |
784 |
$96K |
| 80053 |
|
12,014 |
10,732 |
$92K |
| 96374 |
|
2,118 |
2,020 |
$90K |
| 93005 |
|
4,936 |
4,567 |
$88K |
| 0270 |
|
5,078 |
4,464 |
$81K |
| 74176 |
|
1,046 |
1,009 |
$79K |
| 87811 |
|
2,992 |
2,785 |
$78K |
| 99285 |
|
739 |
696 |
$77K |
| 87635 |
|
2,119 |
1,933 |
$75K |
| 99284 |
|
1,185 |
1,110 |
$73K |
| 0301 |
|
1,423 |
1,213 |
$72K |
| 99281 |
|
917 |
787 |
$72K |
| 85025 |
|
12,870 |
11,359 |
$63K |
| 99199 |
|
1,251 |
941 |
$53K |
| 71045 |
|
4,185 |
3,936 |
$40K |
| 96365 |
|
729 |
706 |
$37K |
| 83880 |
|
1,618 |
1,531 |
$33K |
| 96375 |
|
1,506 |
1,437 |
$28K |
| 96372 |
|
1,669 |
1,562 |
$25K |
| 84484 |
|
3,725 |
3,353 |
$25K |
| 99283 |
|
700 |
653 |
$24K |
| 0250 |
|
2,188 |
1,818 |
$23K |
| 0710 |
|
1,001 |
967 |
$20K |
| 87502 |
|
401 |
386 |
$19K |
| 83690 |
|
3,516 |
3,296 |
$16K |
| Z7502 |
|
436 |
428 |
$15K |
| J3490 |
Drugs unclassified injection |
1,662 |
1,494 |
$15K |
| J7030 |
Normal saline solution infus |
1,995 |
1,746 |
$12K |
| 83605 |
|
1,550 |
1,439 |
$11K |
| 36415 |
|
1,458 |
1,240 |
$10K |
| 87040 |
|
1,074 |
1,036 |
$10K |
| 88305 |
|
626 |
605 |
$9K |
| 85730 |
|
1,823 |
1,735 |
$7K |
| 72125 |
|
56 |
56 |
$7K |
| 85610 |
|
2,526 |
2,399 |
$7K |
| 90853 |
|
18,267 |
1,923 |
$6K |
| 87086 |
|
1,193 |
1,132 |
$6K |
| 99282 |
|
152 |
144 |
$5K |
| 84703 |
|
965 |
921 |
$5K |
| J1885 |
Ketorolac tromethamine inj |
1,049 |
981 |
$4K |
| 82962 |
|
2,536 |
2,144 |
$4K |
| 81001 |
|
1,606 |
1,532 |
$4K |
| A4217 |
Sterile water/saline, 500 ml |
713 |
692 |
$4K |
| 76377 |
|
37 |
37 |
$4K |
| 0914 |
|
89 |
45 |
$4K |
| J2405 |
Ondansetron hcl injection |
904 |
851 |
$3K |
| 84443 |
|
297 |
284 |
$3K |
| 83735 |
|
650 |
547 |
$3K |
| J2270 |
Morphine sulfate injection |
384 |
333 |
$2K |
| 81003 |
|
1,179 |
1,117 |
$2K |
| 71046 |
|
179 |
169 |
$2K |
| 96360 |
|
44 |
36 |
$2K |
| J2060 |
Lorazepam injection |
494 |
458 |
$2K |
| A0429 |
Bls-emergency |
66 |
44 |
$2K |
| 74177 |
|
14 |
13 |
$2K |
| 97140 |
|
187 |
54 |
$2K |
| 94644 |
|
109 |
95 |
$2K |
| 80048 |
|
332 |
299 |
$2K |
| Z7506 |
|
12 |
12 |
$2K |
| 97110 |
|
154 |
43 |
$1K |
| 43239 |
|
39 |
39 |
$1K |
| J0696 |
Ceftriaxone sodium injection |
239 |
220 |
$1K |
| 94640 |
|
76 |
63 |
$1K |
| 76700 |
|
13 |
13 |
$969.83 |
| J7644 |
Ipratropium bromide non-comp |
52 |
40 |
$902.61 |
| 87077 |
|
243 |
241 |
$896.98 |
| 82550 |
|
208 |
199 |
$869.96 |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
138 |
135 |
$790.98 |
| 81025 |
|
220 |
216 |
$680.57 |
| J7120 |
Ringers lactate infusion |
123 |
116 |
$646.74 |
| J2250 |
Inj midazolam hydrochloride |
131 |
123 |
$643.57 |
| 87186 |
|
150 |
148 |
$632.86 |
| 45380 |
|
25 |
25 |
$630.00 |
| 80320 |
|
165 |
151 |
$623.50 |
| 45378 |
|
12 |
12 |
$600.00 |
| 0320 |
|
53 |
50 |
$592.45 |
| 81015 |
|
236 |
212 |
$590.17 |
| 82150 |
|
101 |
99 |
$548.61 |
| 85378 |
|
116 |
110 |
$541.87 |
| 88312 |
|
52 |
52 |
$444.07 |
| J1200 |
Diphenhydramine hcl injectio |
117 |
111 |
$388.47 |
| J0690 |
Cefazolin sodium injection |
26 |
25 |
$343.28 |
| 82553 |
|
43 |
40 |
$330.85 |
| Z7512 |
|
12 |
12 |
$313.56 |
| 90715 |
|
13 |
13 |
$243.25 |
| J3010 |
Fentanyl citrate injection |
41 |
38 |
$200.92 |
| J1644 |
Inj heparin sodium per 1000u |
42 |
38 |
$195.05 |
| 73562 |
|
16 |
16 |
$185.20 |
| 36410 |
|
150 |
131 |
$175.42 |
| J2930 |
Methylprednisolone injection |
14 |
12 |
$83.00 |
| 90832 |
|
131 |
66 |
$52.87 |
| 80329 |
|
38 |
34 |
$40.29 |
| 86901 |
|
26 |
26 |
$39.24 |
| 86900 |
|
27 |
27 |
$34.46 |
| 0760 |
|
32 |
27 |
$34.10 |
| 0258 |
|
27 |
26 |
$27.80 |
| 0305 |
|
21 |
12 |
$0.00 |