| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J0135 |
Adalimumab injection |
547 |
511 |
$1.12M |
| J7324 |
Orthovisc inj per dose |
894 |
891 |
$968K |
| J3490 |
Drugs unclassified injection |
1,843 |
1,647 |
$650K |
| J0897 |
Denosumab injection |
457 |
440 |
$642K |
| J7325 |
Synvisc or synvisc-one |
591 |
584 |
$603K |
| J3590 |
Unclassified biologics |
666 |
636 |
$577K |
| J9355 |
Inj trastuzumab excl biosimi |
182 |
134 |
$515K |
| J9271 |
Inj pembrolizumab |
66 |
54 |
$496K |
| J9217 |
Leuprolide acetate suspnsion |
252 |
246 |
$324K |
| 99601 |
|
3,832 |
940 |
$315K |
| J1100 |
Dexamethasone sodium phos |
1,173 |
976 |
$275K |
| J0585 |
Injection,onabotulinumtoxina |
397 |
395 |
$251K |
| J9035 |
Bevacizumab injection |
61 |
49 |
$222K |
| J1200 |
Diphenhydramine hcl injectio |
810 |
686 |
$183K |
| J2405 |
Ondansetron hcl injection |
769 |
646 |
$150K |
| J1726 |
Makena, 10 mg |
77 |
73 |
$138K |
| J9306 |
Injection, pertuzumab, 1 mg |
36 |
25 |
$126K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
595 |
502 |
$86K |
| J1438 |
Etanercept injection |
63 |
62 |
$70K |
| S9500 |
Hit antibiotic q24h diem |
77 |
36 |
$53K |
| 90750 |
|
478 |
477 |
$51K |
| J1453 |
Fosaprepitant injection |
178 |
155 |
$50K |
| J1626 |
Granisetron hcl injection |
40 |
36 |
$32K |
| S9542 |
Ht inj noc per diem |
783 |
740 |
$28K |
| S0028 |
Injection, famotidine, 20 mg |
290 |
242 |
$28K |
| J3489 |
Zoledronic acid 1mg |
162 |
153 |
$26K |
| A4223 |
Infusion supplies w/o pump |
1,073 |
299 |
$26K |
| J7321 |
Hyalgan supartz visco-3 dose |
38 |
38 |
$20K |
| 90715 |
|
351 |
351 |
$16K |
| S9374 |
Hit hydra 1 liter diem |
65 |
26 |
$9K |
| J1950 |
Leuprolide acetate /3.75 mg |
13 |
13 |
$6K |
| J2790 |
Rho d immune globulin inj |
37 |
37 |
$3K |
| A4230 |
Infus insulin pump non needl |
327 |
65 |
$3K |
| A4927 |
Non-sterile gloves |
1,329 |
1,214 |
$2K |
| J1642 |
Inj heparin sodium per 10 u |
132 |
96 |
$2K |
| J9190 |
Fluorouracil injection |
28 |
25 |
$2K |
| 99602 |
Nursing care in home rn |
15 |
12 |
$2K |
| J2505 |
Injection, pegfilgrastim 6mg |
22 |
17 |
$1K |
| J9045 |
Carboplatin injection |
16 |
13 |
$1K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
90 |
72 |
$995.42 |
| A4212 |
Non coring needle or stylet |
89 |
57 |
$986.60 |
| J2469 |
Palonosetron hcl |
37 |
28 |
$828.69 |
| E0776 |
Iv pole |
12 |
12 |
$821.81 |
| A4245 |
Alcohol wipes per box |
1,174 |
1,117 |
$764.57 |
| J9263 |
Oxaliplatin |
17 |
15 |
$559.68 |
| J1040 |
Methylprednisolone 80 mg inj |
37 |
37 |
$505.27 |
| A4231 |
Infusion insulin pump needle |
69 |
12 |
$339.11 |
| J1050 |
Medroxyprogesterone acetate |
25 |
25 |
$311.90 |
| J9070 |
Cyclophosphamide 100 mg inj |
22 |
16 |
$207.66 |
| A4216 |
Sterile water/saline, 10 ml |
66 |
54 |
$191.30 |
| A6210 |
Foam drg >16<=48 sq in w/o b |
418 |
407 |
$45.58 |
| J9000 |
Doxorubicin hcl injection |
18 |
13 |
$0.00 |