| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J0561 |
Penicillin g benzathine inj |
4,117 |
2,517 |
$852K |
| 90716 |
|
13,187 |
12,945 |
$832K |
| 90472 |
|
44,688 |
42,369 |
$683K |
| 90471 |
|
63,826 |
61,520 |
$579K |
| 90746 |
|
10,093 |
9,850 |
$512K |
| 90707 |
|
11,848 |
11,583 |
$455K |
| 90651 |
|
13,084 |
12,839 |
$397K |
| 90715 |
|
20,049 |
19,519 |
$299K |
| 91320 |
|
2,683 |
2,494 |
$175K |
| 99202 |
|
4,239 |
3,689 |
$138K |
| 90674 |
|
7,279 |
6,976 |
$116K |
| 90480 |
|
3,533 |
3,333 |
$108K |
| 99213 |
|
2,961 |
2,608 |
$106K |
| 90620 |
|
4,423 |
4,341 |
$91K |
| 96372 |
|
7,552 |
5,180 |
$86K |
| 90632 |
|
1,769 |
1,590 |
$78K |
| 90636 |
|
895 |
855 |
$58K |
| 90734 |
|
10,852 |
10,618 |
$44K |
| 99212 |
|
1,695 |
1,520 |
$39K |
| 0124A |
|
1,009 |
988 |
$37K |
| 99203 |
|
704 |
595 |
$36K |
| 90619 |
|
3,241 |
3,202 |
$26K |
| 91322 |
|
299 |
290 |
$26K |
| 36415 |
|
11,434 |
10,218 |
$25K |
| J1050 |
Medroxyprogesterone acetate |
1,477 |
1,228 |
$25K |
| 90756 |
|
1,141 |
1,049 |
$21K |
| 90750 |
|
194 |
192 |
$19K |
| 90661 |
|
1,109 |
1,106 |
$19K |
| 90713 |
|
5,709 |
5,602 |
$17K |
| 90688 |
|
1,820 |
1,773 |
$17K |
| 90739 |
|
2,365 |
2,235 |
$16K |
| 0121A |
|
562 |
520 |
$15K |
| 90710 |
|
7,092 |
6,963 |
$13K |
| 90670 |
|
2,700 |
2,616 |
$12K |
| 0051A |
|
336 |
334 |
$11K |
| 0052A |
|
283 |
282 |
$11K |
| 99214 |
|
177 |
145 |
$10K |
| J7307 |
Etonogestrel implant system |
16 |
13 |
$10K |
| 99204 |
|
96 |
87 |
$7K |
| 81025 |
|
1,783 |
1,409 |
$6K |
| 90714 |
|
619 |
605 |
$5K |
| 90686 |
|
5,769 |
5,633 |
$5K |
| 99211 |
|
322 |
265 |
$3K |
| 99215 |
Prolong outpt/office vis |
15 |
13 |
$2K |
| 90677 |
|
80 |
80 |
$2K |
| 90744 |
|
3,263 |
3,209 |
$2K |
| 99070 |
|
290 |
231 |
$2K |
| 99384 |
|
21 |
21 |
$1K |
| 87591 |
|
108 |
85 |
$1K |
| 87491 |
|
137 |
113 |
$1K |
| 90697 |
|
135 |
134 |
$1K |
| 0054A |
|
34 |
34 |
$1K |
| 0134A |
|
36 |
31 |
$920.00 |
| 90691 |
|
14 |
14 |
$768.34 |
| J0696 |
Ceftriaxone sodium injection |
513 |
474 |
$700.95 |
| U0002 |
Covid-19 lab test non-cdc |
16 |
13 |
$667.33 |
| 87808 |
|
209 |
185 |
$664.23 |
| 86780 |
|
104 |
97 |
$623.07 |
| 87905 |
|
180 |
157 |
$582.23 |
| 90656 |
|
42 |
42 |
$574.29 |
| 69210 |
|
15 |
15 |
$498.31 |
| 91319 |
|
219 |
190 |
$323.08 |
| 86703 |
|
42 |
38 |
$253.17 |
| 90653 |
|
30 |
25 |
$251.53 |
| J8499 |
Oral prescrip drug non chemo |
104 |
80 |
$250.50 |
| U0003 |
Cov-19 amp prb hgh thruput |
60 |
57 |
$187.50 |
| 83655 |
|
30 |
28 |
$177.66 |
| 90648 |
|
1,228 |
1,201 |
$161.37 |
| 91318 |
|
49 |
40 |
$160.00 |
| 90633 |
|
9,273 |
9,112 |
$129.11 |
| 36416 |
|
53 |
53 |
$59.80 |
| 83986 |
|
46 |
40 |
$48.55 |
| Q0144 |
Azithromycin dihydrate, oral |
374 |
295 |
$43.11 |
| A4267 |
Male condom |
359 |
275 |
$31.84 |
| G0008 |
Admin influenza virus vac |
116 |
67 |
$20.00 |
| 90696 |
|
2,514 |
2,477 |
$7.80 |
| 91312 |
|
1,540 |
1,477 |
$7.08 |
| 91305 |
|
544 |
534 |
$3.48 |
| 91313 |
|
31 |
28 |
$0.18 |
| 91315 |
|
29 |
27 |
$0.13 |
| 90698 |
|
743 |
722 |
$0.00 |
| 90723 |
|
1,591 |
1,563 |
$0.00 |
| 99000 |
|
1,241 |
1,203 |
$0.00 |
| T1502 |
Medication admin visit |
328 |
253 |
$0.00 |
| 90694 |
|
18 |
18 |
$0.00 |
| 90700 |
|
3,647 |
3,568 |
$0.00 |
| 91321 |
|
52 |
52 |
$0.00 |
| 90681 |
|
212 |
201 |
$0.00 |
| S0197 |
Prenatal vitamins 30 day |
17 |
14 |
$0.00 |
| 90685 |
|
106 |
103 |
$0.00 |
| 99173 |
|
24 |
23 |
$0.00 |
| 90662 |
|
16 |
15 |
$0.00 |