| Code | Description | Claims | Beneficiaries | Total Paid |
| 0121 |
|
281 |
277 |
$5.12M |
| 87633 |
|
11,900 |
11,003 |
$4.71M |
| 0122 |
|
56 |
56 |
$1.02M |
| Z7502 |
|
24,161 |
23,213 |
$900K |
| 99281 |
|
12,858 |
11,210 |
$849K |
| 99199 |
|
16,180 |
13,540 |
$810K |
| 0450 |
|
14,276 |
12,589 |
$635K |
| 70450 |
|
3,363 |
3,264 |
$563K |
| 87502 |
|
10,988 |
10,642 |
$555K |
| 87486 |
|
11,398 |
11,048 |
$521K |
| 87581 |
|
11,402 |
11,051 |
$508K |
| 80053 |
|
37,268 |
34,329 |
$477K |
| 85025 |
|
38,745 |
35,453 |
$358K |
| 74177 |
|
1,370 |
1,351 |
$283K |
| 84443 |
|
12,539 |
12,207 |
$276K |
| T1999 |
Noc retail items andsupplies |
18,544 |
9,579 |
$211K |
| U0003 |
Cov-19 amp prb hgh thruput |
2,630 |
2,467 |
$204K |
| 74176 |
|
1,991 |
1,943 |
$201K |
| 93005 |
|
9,017 |
8,356 |
$198K |
| 87491 |
|
3,899 |
3,795 |
$183K |
| 87591 |
|
3,899 |
3,795 |
$181K |
| Z7610 |
|
14,726 |
10,355 |
$181K |
| 82306 |
|
6,258 |
6,226 |
$180K |
| 80061 |
|
10,385 |
10,304 |
$170K |
| 97110 |
|
7,704 |
1,649 |
$158K |
| 77067 |
|
1,255 |
1,255 |
$146K |
| 87635 |
|
2,862 |
2,762 |
$133K |
| G0480 |
Drug test def 1-7 classes |
2,204 |
2,080 |
$130K |
| 71045 |
|
8,841 |
8,380 |
$126K |
| 96365 |
|
1,443 |
1,363 |
$126K |
| 99460 |
|
121 |
120 |
$125K |
| 93306 |
|
1,049 |
976 |
$121K |
| 87631 |
|
1,995 |
1,962 |
$121K |
| 83036 |
|
9,104 |
8,987 |
$117K |
| 72125 |
|
510 |
505 |
$111K |
| 84439 |
|
8,694 |
8,583 |
$104K |
| 80307 |
|
1,824 |
1,734 |
$101K |
| 99213 |
|
1,427 |
1,070 |
$99K |
| 87507 |
|
212 |
208 |
$98K |
| 83690 |
|
11,307 |
10,567 |
$92K |
| 83880 |
|
3,241 |
3,047 |
$92K |
| 76856 |
|
1,327 |
1,310 |
$92K |
| 96374 |
|
1,289 |
1,225 |
$89K |
| 76830 |
|
1,106 |
1,089 |
$77K |
| 76705 |
|
1,209 |
1,168 |
$76K |
| 84484 |
|
6,730 |
6,317 |
$73K |
| 76805 |
|
827 |
813 |
$70K |
| 97139 |
|
3,041 |
550 |
$66K |
| 87651 |
|
1,371 |
1,344 |
$65K |
| 71250 |
|
230 |
228 |
$61K |
| 59409 |
|
114 |
112 |
$60K |
| 80150 |
|
3,587 |
3,245 |
$55K |
| 81025 |
|
6,667 |
6,270 |
$50K |
| 76700 |
|
551 |
551 |
$50K |
| 96375 |
|
1,586 |
1,496 |
$49K |
| 76801 |
|
891 |
818 |
$47K |
| 87389 |
|
2,110 |
2,011 |
$47K |
| 94664 |
|
3,229 |
2,807 |
$46K |
| 84145 |
|
2,182 |
2,089 |
$45K |
| 87086 |
|
5,715 |
5,323 |
$43K |
| 77063 |
|
1,162 |
1,162 |
$43K |
| 80055 |
|
722 |
722 |
$42K |
| 82542 |
|
1,698 |
1,603 |
$41K |
| G2023 |
Specimen collect covid-19 |
2,424 |
2,331 |
$40K |
| 86803 |
|
1,843 |
1,836 |
$37K |
| 81001 |
|
9,157 |
8,581 |
$36K |
| 81003 |
|
11,718 |
10,879 |
$30K |
| 83605 |
|
2,197 |
2,096 |
$26K |
| 86140 |
|
4,096 |
3,944 |
$26K |
| 71046 |
|
1,086 |
1,056 |
$25K |
| 97140 |
|
524 |
222 |
$25K |
| 76816 |
|
352 |
339 |
$24K |
| 59025 |
|
864 |
544 |
$23K |
| 99223 |
Prolong inpt eval add15 m |
305 |
298 |
$22K |
| 82728 |
|
1,614 |
1,599 |
$22K |
| J1885 |
Ketorolac tromethamine inj |
3,785 |
3,572 |
$21K |
| 72148 |
|
25 |
25 |
$21K |
| 36415 |
|
15,879 |
13,913 |
$20K |
| 96372 |
|
1,028 |
972 |
$20K |
| J1100 |
Dexamethasone sodium phos |
3,823 |
3,652 |
$20K |
| 99233 |
Prolong inpt eval add15 m |
466 |
155 |
$18K |
| 99243 |
|
244 |
244 |
$18K |
| 73610 |
|
601 |
570 |
$18K |
| 76536 |
|
233 |
233 |
$18K |
| 73630 |
|
671 |
641 |
$18K |
| 99283 |
|
241 |
222 |
$17K |
| 72131 |
|
56 |
56 |
$17K |
| 73030 |
|
549 |
538 |
$17K |
| 81513 |
|
94 |
92 |
$16K |
| 80143 |
|
1,071 |
987 |
$16K |
| 83550 |
|
1,586 |
1,568 |
$16K |
| 76817 |
|
242 |
205 |
$16K |
| 99284 |
|
105 |
102 |
$16K |
| 99239 |
|
308 |
302 |
$16K |
| 97530 |
|
818 |
411 |
$15K |
| 87661 |
|
356 |
349 |
$15K |
| 76770 |
|
139 |
138 |
$15K |
| 80179 |
|
978 |
897 |
$15K |
| 99291 |
|
84 |
83 |
$15K |
| 73721 |
|
25 |
25 |
$14K |
| 83540 |
|
1,713 |
1,692 |
$14K |
| 73562 |
|
495 |
487 |
$13K |
| 83735 |
|
1,708 |
1,577 |
$13K |
| 93307 |
|
168 |
125 |
$12K |
| 84702 |
|
1,136 |
934 |
$12K |
| J3490 |
Drugs unclassified injection |
464 |
129 |
$12K |
| 77066 |
Tomosynthesis, mammo |
78 |
78 |
$11K |
| 82043 |
|
1,350 |
1,344 |
$11K |
| 87186 |
|
1,707 |
1,644 |
$10K |
| 76982 |
|
112 |
112 |
$10K |
| 93971 |
|
64 |
63 |
$10K |
| 87040 |
|
953 |
924 |
$10K |
| J2405 |
Ondansetron hcl injection |
1,964 |
1,812 |
$9K |
| 93010 |
|
958 |
791 |
$9K |
| 82607 |
|
805 |
803 |
$9K |
| 82746 |
|
425 |
421 |
$9K |
| 87077 |
|
1,922 |
1,857 |
$9K |
| 74018 |
|
415 |
394 |
$8K |
| 80048 |
|
816 |
766 |
$8K |
| 85730 |
|
1,263 |
1,210 |
$8K |
| 73110 |
|
245 |
221 |
$8K |
| 99282 |
|
517 |
486 |
$8K |
| 76642 |
|
132 |
131 |
$8K |
| 96366 |
|
241 |
237 |
$7K |
| 73130 |
|
244 |
234 |
$7K |
| 0762 |
|
153 |
95 |
$7K |
| 99285 |
|
46 |
45 |
$7K |
| 99232 |
|
174 |
87 |
$7K |
| J0131 |
Inj, acetaminophen (nos) |
1,287 |
828 |
$7K |
| 99238 |
|
172 |
166 |
$6K |
| 87798 |
|
264 |
256 |
$6K |
| 85651 |
|
1,341 |
1,312 |
$6K |
| 84436 |
|
664 |
622 |
$5K |
| 82550 |
|
793 |
750 |
$5K |
| J1200 |
Diphenhydramine hcl injectio |
838 |
784 |
$5K |
| 87481 |
|
96 |
94 |
$5K |
| 85610 |
|
1,080 |
960 |
$5K |
| J0696 |
Ceftriaxone sodium injection |
934 |
850 |
$5K |
| 87420 |
|
425 |
420 |
$5K |
| J2270 |
Morphine sulfate injection |
634 |
518 |
$5K |
| 45380 |
|
38 |
24 |
$5K |
| 73700 |
|
13 |
13 |
$4K |
| 97161 |
|
81 |
80 |
$4K |
| 87081 |
|
457 |
455 |
$4K |
| 99000 |
|
1,210 |
1,189 |
$4K |
| 99222 |
|
69 |
69 |
$4K |
| 97035 |
|
295 |
95 |
$4K |
| 93000 |
|
105 |
102 |
$4K |
| 0011A |
|
91 |
91 |
$4K |
| 72100 |
|
86 |
86 |
$4K |
| G0279 |
Tomosynthesis, mammo |
108 |
108 |
$3K |
| J2060 |
Lorazepam injection |
570 |
482 |
$3K |
| 97010 |
|
199 |
86 |
$3K |
| 0012A |
|
83 |
83 |
$3K |
| 84153 |
|
120 |
118 |
$3K |
| 87880 |
|
270 |
266 |
$3K |
| 86850 |
|
239 |
225 |
$3K |
| 97112 |
|
132 |
56 |
$3K |
| 0160 |
|
48 |
31 |
$3K |
| 88305 |
|
100 |
99 |
$3K |
| 87070 |
|
231 |
228 |
$3K |
| 76641 |
|
44 |
44 |
$3K |
| 86592 |
|
515 |
510 |
$3K |
| 82950 |
|
381 |
380 |
$2K |
| 80299 |
|
151 |
125 |
$2K |
| 73560 |
|
93 |
90 |
$2K |
| 99214 |
|
70 |
63 |
$2K |
| 90715 |
|
38 |
38 |
$2K |
| 73564 |
|
57 |
57 |
$2K |
| 99462 |
|
67 |
49 |
$2K |
| 82150 |
|
209 |
204 |
$2K |
| 96367 |
|
38 |
38 |
$2K |
| 73502 |
|
38 |
38 |
$2K |
| 87634 |
|
29 |
29 |
$2K |
| 0270 |
|
766 |
462 |
$2K |
| 73080 |
|
42 |
37 |
$1K |
| 97014 |
|
75 |
27 |
$1K |
| C9803 |
Hopd covid-19 spec collect |
117 |
113 |
$1K |
| 73140 |
|
62 |
57 |
$1K |
| 0721 |
|
65 |
51 |
$1K |
| 87811 |
|
29 |
29 |
$1K |
| J0780 |
Prochlorperazine injection |
95 |
93 |
$1K |
| 0004A |
|
29 |
29 |
$1K |
| 82140 |
|
77 |
72 |
$1K |
| 0064A |
|
26 |
26 |
$1K |
| 86308 |
|
137 |
135 |
$1K |
| Z7500 |
|
29 |
26 |
$988.90 |
| 94640 |
|
51 |
36 |
$977.54 |
| 99212 |
|
23 |
22 |
$970.05 |
| 76811 |
|
12 |
12 |
$969.36 |
| 97535 |
|
41 |
31 |
$950.38 |
| 72110 |
|
13 |
13 |
$933.17 |
| 76815 |
|
12 |
12 |
$900.82 |
| 82570 |
|
105 |
103 |
$827.59 |
| 83970 |
|
13 |
13 |
$821.08 |
| 85044 |
|
117 |
114 |
$771.03 |
| 84550 |
|
128 |
113 |
$751.72 |
| 84100 |
|
105 |
104 |
$717.75 |
| 85027 |
|
74 |
74 |
$693.00 |
| 87641 |
|
14 |
14 |
$661.50 |
| 84156 |
|
129 |
124 |
$640.35 |
| 85378 |
|
40 |
39 |
$553.15 |
| 82977 |
|
58 |
57 |
$542.70 |
| 0071A |
|
13 |
13 |
$520.00 |
| 0002A |
|
13 |
13 |
$520.00 |
| J2704 |
Inj, propofol, 10 mg |
130 |
92 |
$515.89 |
| 84460 |
|
68 |
61 |
$486.60 |
| X3910 |
|
47 |
12 |
$462.48 |
| 99001 |
|
2,394 |
2,329 |
$438.02 |
| 93225 |
|
12 |
12 |
$414.15 |
| 82947 |
|
69 |
65 |
$297.91 |
| 87071 |
|
40 |
39 |
$279.65 |
| 81002 |
|
141 |
63 |
$278.21 |
| 86430 |
|
29 |
29 |
$262.92 |
| 82010 |
|
28 |
27 |
$237.29 |
| 82951 |
|
12 |
12 |
$236.28 |
| J2765 |
Metoclopramide hcl injection |
41 |
41 |
$223.97 |
| 93244 |
|
12 |
12 |
$190.59 |
| 29515 |
|
14 |
14 |
$184.38 |
| 82247 |
|
21 |
14 |
$153.60 |
| J3301 |
Triamcinolone acet inj nos |
30 |
26 |
$149.45 |
| 96376 |
|
42 |
42 |
$135.30 |
| 82248 |
|
17 |
12 |
$130.56 |
| 0251 |
|
129 |
117 |
$94.30 |
| 0250 |
|
188 |
178 |
$92.90 |
| J0665 |
Inj, bupivacaine, nos, 0.5mg |
12 |
12 |
$82.08 |
| J2470 |
Inj pantoprazole sodium 40mg |
12 |
12 |
$67.06 |
| 0300 |
|
437 |
427 |
$50.26 |
| 96379 |
|
314 |
206 |
$24.00 |
| A9270 |
Non-covered item or service |
345 |
284 |
$16.20 |
| 0306 |
|
213 |
207 |
$15.23 |
| 0258 |
|
437 |
421 |
$11.78 |
| 0636 |
|
325 |
317 |
$9.74 |
| 0301 |
|
311 |
304 |
$9.65 |
| 0637 |
|
51 |
51 |
$5.40 |
| 0305 |
|
401 |
395 |
$4.97 |
| 81015 |
|
44 |
42 |
$3.05 |
| 0307 |
|
212 |
206 |
$2.03 |
| 3074F |
|
124 |
114 |
$0.00 |
| 0259R |
|
159 |
152 |
$0.00 |
| 0271R |
|
111 |
109 |
$0.00 |
| 0324 |
|
96 |
95 |
$0.00 |
| 0720 |
|
13 |
13 |
$0.00 |
| 80320 |
|
30 |
25 |
$0.00 |
| 0352 |
|
70 |
69 |
$0.00 |
| 0250R |
|
173 |
159 |
$0.00 |
| 0302 |
|
316 |
310 |
$0.00 |
| 0258R |
|
53 |
51 |
$0.00 |
| 0272R |
|
228 |
214 |
$0.00 |
| 0730 |
|
97 |
93 |
$0.00 |
| 0460 |
|
90 |
88 |
$0.00 |
| 3078F |
|
133 |
124 |
$0.00 |
| 0470 |
|
27 |
26 |
$0.00 |
| 0252 |
|
38 |
38 |
$0.00 |
| 0412 |
|
14 |
13 |
$0.00 |
| 0272 |
|
14 |
14 |
$0.00 |