| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 0450 |
|
23,689 |
20,395 |
$3.53M |
| 0360 |
|
5,182 |
1,901 |
$358K |
| 0623 |
|
12,221 |
3,964 |
$281K |
| 0761 |
|
5,019 |
2,725 |
$175K |
| 99283 |
|
935 |
899 |
$67K |
| 0420 |
|
1,744 |
350 |
$59K |
| 99284 |
|
685 |
660 |
$56K |
| G0463 |
Hospital outpt clinic visit |
1,044 |
736 |
$41K |
| 11042 |
|
2,579 |
1,139 |
$38K |
| 99213 |
|
635 |
273 |
$25K |
| 0430 |
|
726 |
89 |
$15K |
| A6457 |
Tubular dressing |
1,759 |
754 |
$9K |
| 80053 |
|
2,010 |
1,931 |
$8K |
| 85025 |
|
1,902 |
1,823 |
$5K |
| 96374 |
|
320 |
308 |
$5K |
| 97597 |
|
560 |
370 |
$4K |
| Z7502 |
|
115 |
113 |
$4K |
| 0306 |
|
720 |
199 |
$4K |
| 0301 |
|
6,334 |
2,574 |
$3K |
| 97140 |
|
707 |
218 |
$3K |
| 93005 |
|
432 |
407 |
$3K |
| 0320 |
|
538 |
479 |
$3K |
| 87635 |
|
51 |
49 |
$2K |
| 99285 |
|
238 |
225 |
$2K |
| 71046 |
|
279 |
274 |
$2K |
| 97110 |
|
1,212 |
378 |
$2K |
| 99281 |
|
25 |
25 |
$2K |
| 0250 |
|
8,041 |
3,848 |
$2K |
| 87077 |
|
368 |
311 |
$1K |
| 81001 |
|
190 |
181 |
$809.64 |
| 87502 |
|
68 |
67 |
$735.72 |
| 87070 |
|
459 |
420 |
$730.40 |
| 70450 |
|
12 |
12 |
$656.26 |
| 0402 |
|
13 |
12 |
$654.42 |
| J3490 |
Drugs unclassified injection |
99 |
64 |
$561.72 |
| 87186 |
|
249 |
211 |
$535.38 |
| A6210 |
Foam drg >16<=48 sq in w/o b |
908 |
471 |
$501.27 |
| 96375 |
|
67 |
63 |
$382.47 |
| 96365 |
|
31 |
29 |
$380.16 |
| 81003 |
|
276 |
264 |
$345.52 |
| 87086 |
|
26 |
24 |
$315.46 |
| 84484 |
|
278 |
244 |
$260.65 |
| 0305 |
|
1,299 |
956 |
$210.78 |
| 83690 |
|
150 |
150 |
$191.31 |
| 82805 |
|
31 |
27 |
$164.56 |
| 0260 |
|
128 |
67 |
$159.47 |
| 87205 |
|
334 |
306 |
$149.66 |
| A6021 |
Collagen dressing <=16 sq in |
1,159 |
559 |
$145.08 |
| 84703 |
|
28 |
27 |
$116.13 |
| 94640 |
|
19 |
18 |
$99.13 |
| 97530 |
|
30 |
14 |
$77.78 |
| 86140 |
|
85 |
85 |
$76.90 |
| J1885 |
Ketorolac tromethamine inj |
15 |
15 |
$72.62 |
| 82375 |
|
45 |
39 |
$62.59 |
| A6212 |
Foam drg <=16 sq in w/border |
155 |
85 |
$58.43 |
| J2405 |
Ondansetron hcl injection |
12 |
12 |
$54.42 |
| 83605 |
|
31 |
27 |
$51.32 |
| 85027 |
|
73 |
72 |
$51.26 |
| 71045 |
|
42 |
42 |
$48.76 |
| 80047 |
|
25 |
25 |
$22.02 |
| 82947 |
|
45 |
28 |
$14.63 |
| 97010 |
|
76 |
27 |
$13.89 |
| 85007 |
|
12 |
12 |
$9.62 |
| 85652 |
|
13 |
13 |
$3.86 |
| A6196 |
Alginate dressing <=16 sq in |
569 |
309 |
$2.16 |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
67 |
67 |
$1.94 |
| 99070 |
|
838 |
597 |
$0.00 |
| 0307 |
|
88 |
87 |
$0.00 |
| A6199 |
Alginate drsg wound filler |
97 |
53 |
$0.00 |
| 0730 |
|
24 |
24 |
$0.00 |