| Code | Description | Claims | Beneficiaries | Total Paid |
| 0450 |
|
197,540 |
181,879 |
$5.65M |
| T1999 |
Noc retail items andsupplies |
8,413 |
6,721 |
$1.67M |
| 99199 |
|
13,667 |
13,165 |
$1.05M |
| J3490 |
Drugs unclassified injection |
18,114 |
14,123 |
$1000K |
| 0270 |
|
74,041 |
42,554 |
$877K |
| 36415 |
|
17,782 |
15,167 |
$606K |
| 0250 |
|
24,171 |
16,085 |
$574K |
| 87426 |
|
18,674 |
18,351 |
$316K |
| 96374 |
|
14,094 |
13,202 |
$214K |
| 71045 |
|
30,828 |
29,285 |
$210K |
| 93005 |
|
33,040 |
30,735 |
$202K |
| 87400 |
|
11,516 |
11,403 |
$187K |
| 80053 |
|
53,013 |
49,989 |
$184K |
| 96372 |
|
13,791 |
12,386 |
$181K |
| 74177 |
|
4,231 |
4,097 |
$167K |
| 85027 |
|
75,867 |
69,562 |
$131K |
| 70450 |
|
6,085 |
5,848 |
$130K |
| 96361 |
|
9,052 |
8,150 |
$104K |
| 0762 |
|
765 |
436 |
$91K |
| 71046 |
|
5,564 |
5,399 |
$89K |
| U0002 |
Covid-19 lab test non-cdc |
2,993 |
2,958 |
$76K |
| 87635 |
|
3,750 |
3,678 |
$66K |
| 87651 |
|
4,935 |
4,905 |
$57K |
| 83690 |
|
32,170 |
30,498 |
$52K |
| 84484 |
|
22,171 |
19,042 |
$49K |
| 87633 |
|
324 |
314 |
$47K |
| 81001 |
|
25,640 |
24,471 |
$43K |
| 96375 |
|
6,122 |
5,450 |
$43K |
| 76705 |
|
3,854 |
3,726 |
$41K |
| 74176 |
|
1,614 |
1,576 |
$40K |
| 84702 |
|
13,490 |
12,487 |
$38K |
| 96360 |
|
2,376 |
2,287 |
$37K |
| 87086 |
|
6,544 |
6,239 |
$35K |
| 80307 |
|
3,844 |
3,478 |
$35K |
| 99283 |
|
944 |
877 |
$30K |
| C1729 |
Cath, drainage |
5,406 |
5,066 |
$28K |
| 66984 |
|
103 |
103 |
$28K |
| 80047 |
|
7,328 |
6,811 |
$27K |
| 72125 |
|
1,622 |
1,559 |
$27K |
| 94640 |
|
2,634 |
2,404 |
$25K |
| 87430 |
|
2,455 |
2,363 |
$23K |
| 71275 |
|
363 |
357 |
$22K |
| 0272 |
|
4,626 |
4,020 |
$21K |
| J1885 |
Ketorolac tromethamine inj |
16,204 |
10,668 |
$19K |
| J7030 |
Normal saline solution infus |
13,235 |
12,012 |
$19K |
| 76856 |
|
1,297 |
1,271 |
$17K |
| 76801 |
|
852 |
719 |
$16K |
| 87081 |
|
1,542 |
1,484 |
$15K |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
10,327 |
6,125 |
$15K |
| 72100 |
|
723 |
714 |
$14K |
| 73610 |
|
1,444 |
1,412 |
$14K |
| 80048 |
|
6,692 |
6,259 |
$14K |
| 96365 |
|
1,717 |
1,647 |
$13K |
| 73030 |
|
1,093 |
1,052 |
$13K |
| 73630 |
|
1,138 |
1,108 |
$13K |
| 73130 |
|
822 |
802 |
$12K |
| 81003 |
|
3,093 |
2,950 |
$12K |
| 73562 |
|
860 |
841 |
$12K |
| 80076 |
|
6,573 |
6,215 |
$12K |
| 71260 |
|
292 |
267 |
$12K |
| 99284 |
|
313 |
293 |
$11K |
| 83880 |
|
3,277 |
3,053 |
$11K |
| 70551 |
|
111 |
110 |
$11K |
| 87634 |
|
811 |
803 |
$11K |
| 76830 |
|
680 |
666 |
$10K |
| 87804 |
|
1,642 |
1,454 |
$10K |
| 73140 |
|
394 |
385 |
$10K |
| 94644 |
|
485 |
437 |
$10K |
| 93971 |
|
272 |
265 |
$9K |
| 74018 |
|
813 |
802 |
$9K |
| 70486 |
|
239 |
236 |
$8K |
| 93306 |
|
150 |
141 |
$8K |
| 87077 |
|
1,739 |
1,682 |
$8K |
| 87486 |
|
327 |
317 |
$8K |
| 83605 |
|
4,695 |
4,079 |
$8K |
| 85730 |
|
7,905 |
7,644 |
$7K |
| 76817 |
|
307 |
258 |
$7K |
| 82550 |
|
6,563 |
5,955 |
$7K |
| 81025 |
|
3,081 |
3,038 |
$7K |
| J0561 |
Penicillin g benzathine inj |
114 |
113 |
$7K |
| 87040 |
|
3,805 |
3,084 |
$7K |
| 73560 |
|
357 |
344 |
$6K |
| 85610 |
|
9,044 |
8,687 |
$6K |
| J1100 |
Dexamethasone sodium phos |
3,459 |
2,939 |
$6K |
| 73110 |
|
373 |
365 |
$6K |
| 87491 |
|
1,367 |
1,330 |
$5K |
| 73502 |
|
242 |
241 |
$5K |
| 73590 |
|
507 |
497 |
$5K |
| 0258 |
|
505 |
299 |
$5K |
| 87581 |
|
327 |
317 |
$4K |
| 90715 |
|
1,556 |
1,521 |
$4K |
| 84443 |
|
1,591 |
1,527 |
$4K |
| J2405 |
Ondansetron hcl injection |
4,741 |
4,344 |
$4K |
| 72170 |
|
564 |
539 |
$4K |
| 87798 |
|
327 |
317 |
$3K |
| 83735 |
|
3,796 |
3,365 |
$3K |
| 87591 |
|
1,371 |
1,334 |
$3K |
| J0696 |
Ceftriaxone sodium injection |
1,566 |
1,278 |
$3K |
| 73090 |
|
221 |
215 |
$3K |
| 87186 |
|
1,665 |
1,599 |
$2K |
| 99211 |
|
220 |
198 |
$2K |
| 73620 |
|
154 |
150 |
$2K |
| 82077 |
|
1,480 |
1,388 |
$2K |
| 93017 |
|
80 |
78 |
$2K |
| Q0162 |
Ondansetron oral |
6,083 |
5,820 |
$2K |
| 99282 |
|
41 |
40 |
$2K |
| 99281 |
|
40 |
39 |
$2K |
| 0360 |
|
26 |
26 |
$2K |
| 73080 |
|
108 |
107 |
$2K |
| 0710 |
|
199 |
197 |
$2K |
| J2270 |
Morphine sulfate injection |
1,360 |
1,222 |
$2K |
| V2632 |
Post chmbr intraocular lens |
13 |
13 |
$2K |
| A9500 |
Tc99m sestamibi |
36 |
36 |
$2K |
| 85379 |
|
957 |
927 |
$2K |
| J1170 |
Hydromorphone injection |
715 |
592 |
$1K |
| 73600 |
|
62 |
61 |
$1K |
| 82330 |
|
385 |
369 |
$1K |
| 76815 |
|
76 |
73 |
$1K |
| 73070 |
|
41 |
40 |
$1K |
| 86901 |
|
2,445 |
2,310 |
$1K |
| J2765 |
Metoclopramide hcl injection |
708 |
684 |
$1K |
| 96376 |
|
1,242 |
1,015 |
$1K |
| 96366 |
|
110 |
101 |
$1K |
| 86900 |
|
2,445 |
2,310 |
$1K |
| 87210 |
|
374 |
368 |
$1K |
| 73552 |
|
74 |
73 |
$1K |
| G0378 |
Hospital observation per hr |
31 |
15 |
$978.24 |
| 0720 |
|
20 |
17 |
$956.54 |
| 93970 |
|
12 |
12 |
$918.21 |
| 70360 |
|
43 |
43 |
$887.80 |
| 82553 |
|
382 |
362 |
$831.74 |
| 86850 |
|
1,512 |
1,463 |
$818.07 |
| 73120 |
|
41 |
41 |
$715.04 |
| 12001 |
|
152 |
145 |
$668.88 |
| 70498 |
|
15 |
15 |
$654.24 |
| 87147 |
|
257 |
249 |
$637.03 |
| 86140 |
|
748 |
731 |
$630.11 |
| L4350 |
Ankle control ortho pre ots |
13 |
13 |
$613.35 |
| 0510 |
|
250 |
229 |
$607.02 |
| 76870 |
|
54 |
53 |
$551.74 |
| J1200 |
Diphenhydramine hcl injectio |
382 |
365 |
$544.68 |
| 73100 |
|
40 |
40 |
$516.68 |
| 70496 |
|
15 |
15 |
$488.00 |
| J2060 |
Lorazepam injection |
432 |
390 |
$458.07 |
| 82248 |
|
380 |
375 |
$448.49 |
| J2930 |
Methylprednisolone injection |
210 |
194 |
$414.58 |
| 80061 |
|
151 |
137 |
$403.99 |
| 84439 |
|
178 |
175 |
$403.29 |
| 76770 |
|
12 |
12 |
$370.50 |
| 99285 |
|
79 |
62 |
$361.69 |
| J7040 |
Normal saline solution infus |
316 |
307 |
$331.46 |
| 87420 |
|
144 |
128 |
$308.60 |
| J1650 |
Inj enoxaparin sodium |
110 |
69 |
$293.74 |
| J7050 |
Normal saline solution infus |
490 |
457 |
$271.03 |
| 85007 |
|
329 |
321 |
$243.41 |
| J1815 |
Insulin injection |
301 |
207 |
$227.97 |
| J7512 |
Prednisone ir or dr oral 1mg |
810 |
749 |
$225.53 |
| 87088 |
|
83 |
79 |
$219.19 |
| 85651 |
|
336 |
328 |
$179.65 |
| 72040 |
|
12 |
12 |
$169.17 |
| 83036 |
|
108 |
97 |
$162.10 |
| J0780 |
Prochlorperazine injection |
25 |
25 |
$121.97 |
| 90471 |
|
1,647 |
1,589 |
$116.79 |
| 90714 |
|
70 |
70 |
$96.87 |
| 82140 |
|
31 |
31 |
$91.02 |
| 84100 |
|
58 |
57 |
$66.92 |
| J7120 |
Ringers lactate infusion |
13 |
12 |
$59.69 |
| 11043 |
|
26 |
12 |
$55.20 |
| J3010 |
Fentanyl citrate injection |
69 |
64 |
$45.64 |
| 73660 |
|
13 |
13 |
$44.94 |
| 82310 |
|
26 |
26 |
$42.30 |
| J7510 |
Prednisolone oral per 5 mg |
153 |
150 |
$38.50 |
| G0463 |
Hospital outpt clinic visit |
75 |
54 |
$35.76 |
| A9270 |
Non-covered item or service |
2,766 |
1,102 |
$29.75 |
| 0259 |
|
33 |
19 |
$18.30 |
| J0456 |
Azithromycin |
47 |
45 |
$14.63 |
| J7613 |
Albuterol non-comp unit |
289 |
275 |
$8.71 |
| J7611 |
Albuterol non-comp con |
15 |
15 |
$2.50 |
| J2250 |
Inj midazolam hydrochloride |
16 |
15 |
$0.94 |
| S0028 |
Injection, famotidine, 20 mg |
44 |
43 |
$0.00 |
| 12011 |
|
53 |
53 |
$0.00 |
| G1003 |
Cdsm medicalis |
48 |
48 |
$0.00 |
| 82009 |
|
13 |
12 |
$0.00 |
| J7620 |
Albuterol ipratrop non-comp |
117 |
111 |
$0.00 |
| J2543 |
Piperacillin/tazobactam |
43 |
42 |
$0.00 |
| J1940 |
Furosemide injection |
15 |
13 |
$0.00 |
| J7999 |
Compounded drug, noc |
27 |
27 |
$0.00 |