| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99282 |
|
2,562 |
2,283 |
$160K |
| G0463 |
Hospital outpt clinic visit |
7,341 |
2,514 |
$101K |
| A9270 |
Non-covered item or service |
4,330 |
1,774 |
$59K |
| 99283 |
|
1,275 |
1,151 |
$51K |
| 36415 |
|
542 |
463 |
$47K |
| J3490 |
Drugs unclassified injection |
1,195 |
686 |
$34K |
| 0202U |
|
82 |
77 |
$27K |
| 99281 |
|
278 |
258 |
$17K |
| 96374 |
|
613 |
508 |
$10K |
| 80053 |
|
752 |
665 |
$8K |
| J7030 |
Normal saline solution infus |
16 |
13 |
$7K |
| 87400 |
|
148 |
70 |
$6K |
| A4216 |
Sterile water/saline, 10 ml |
40 |
25 |
$5K |
| 99284 |
|
187 |
157 |
$3K |
| 85025 |
|
1,671 |
1,426 |
$3K |
| 81001 |
|
139 |
121 |
$3K |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
126 |
25 |
$2K |
| 87804 |
|
28 |
13 |
$1K |
| 96375 |
|
255 |
209 |
$976.17 |
| 99285 |
|
29 |
25 |
$560.64 |
| 11721 |
|
29 |
14 |
$340.90 |
| G0008 |
Admin influenza virus vac |
72 |
13 |
$316.55 |
| 87807 |
|
15 |
14 |
$157.93 |
| C9803 |
Hopd covid-19 spec collect |
193 |
183 |
$85.10 |
| 96361 |
|
29 |
25 |
$45.26 |
| J1885 |
Ketorolac tromethamine inj |
132 |
102 |
$0.00 |
| 80048 |
|
16 |
14 |
$0.00 |
| J2405 |
Ondansetron hcl injection |
204 |
162 |
$0.00 |