| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 80053 |
|
13,714 |
9,651 |
$321K |
| 87426 |
|
2,943 |
2,487 |
$100K |
| 80050 |
|
2,512 |
2,213 |
$97K |
| 85025 |
|
14,367 |
10,077 |
$89K |
| 87430 |
|
7,040 |
5,824 |
$75K |
| 36415 |
|
9,328 |
6,365 |
$45K |
| 82306 |
|
1,685 |
1,388 |
$37K |
| 87804 |
|
4,654 |
2,091 |
$36K |
| 97110 |
|
1,803 |
273 |
$33K |
| 70450 |
|
402 |
287 |
$32K |
| 80061 |
|
3,055 |
2,590 |
$28K |
| 84443 |
|
3,693 |
3,025 |
$28K |
| U0002 |
Covid-19 lab test non-cdc |
636 |
590 |
$26K |
| 82553 |
|
1,770 |
1,074 |
$22K |
| 82550 |
|
1,844 |
1,108 |
$22K |
| 96365 |
|
257 |
208 |
$21K |
| 83735 |
|
3,984 |
2,861 |
$21K |
| 87088 |
|
2,250 |
1,800 |
$19K |
| 83036 |
|
2,631 |
2,167 |
$18K |
| 96372 |
|
783 |
545 |
$18K |
| 93005 |
|
3,162 |
2,093 |
$17K |
| 74018 |
|
1,204 |
886 |
$17K |
| 71045 |
|
2,175 |
1,479 |
$16K |
| T1015 |
Clinic service |
1,696 |
1,173 |
$15K |
| 71046 |
|
1,119 |
890 |
$14K |
| 83874 |
|
1,764 |
1,071 |
$13K |
| 87420 |
|
1,202 |
1,005 |
$13K |
| 81001 |
|
4,167 |
3,051 |
$12K |
| 84484 |
|
1,792 |
1,080 |
$11K |
| 80048 |
|
782 |
588 |
$11K |
| 96374 |
|
150 |
116 |
$10K |
| 82150 |
|
1,159 |
850 |
$9K |
| 87400 |
|
1,598 |
1,466 |
$9K |
| 81002 |
|
3,060 |
2,235 |
$9K |
| 99283 |
|
924 |
508 |
$9K |
| 83690 |
|
1,038 |
769 |
$9K |
| 83880 |
|
453 |
312 |
$8K |
| 81025 |
|
1,072 |
900 |
$8K |
| 82607 |
|
671 |
558 |
$8K |
| 80305 |
|
835 |
584 |
$8K |
| 84439 |
|
1,228 |
997 |
$8K |
| 99284 |
|
544 |
314 |
$7K |
| 99285 |
|
592 |
282 |
$7K |
| 77067 |
|
151 |
132 |
$7K |
| J0696 |
Ceftriaxone sodium injection |
1,284 |
856 |
$6K |
| 87633 |
|
26 |
18 |
$6K |
| 87077 |
|
454 |
359 |
$5K |
| 85027 |
|
937 |
660 |
$5K |
| 85652 |
|
1,479 |
1,198 |
$4K |
| 85379 |
|
852 |
560 |
$4K |
| 85007 |
|
994 |
700 |
$3K |
| 85730 |
|
745 |
499 |
$2K |
| 85651 |
|
731 |
582 |
$2K |
| 99213 |
|
184 |
113 |
$2K |
| 82962 |
|
382 |
268 |
$2K |
| 87186 |
|
313 |
251 |
$2K |
| J1885 |
Ketorolac tromethamine inj |
709 |
475 |
$2K |
| 85610 |
|
814 |
536 |
$2K |
| 87637 |
|
12 |
12 |
$2K |
| G0463 |
Hospital outpt clinic visit |
124 |
57 |
$1K |
| 74022 |
|
79 |
54 |
$1K |
| 87591 |
|
32 |
31 |
$1K |
| 96360 |
|
17 |
12 |
$1K |
| 82947 |
|
403 |
304 |
$1K |
| 86803 |
|
82 |
69 |
$998.50 |
| 99214 |
|
128 |
72 |
$856.22 |
| 87110 |
|
32 |
31 |
$783.44 |
| 94640 |
|
234 |
105 |
$727.83 |
| 82043 |
|
127 |
107 |
$723.92 |
| 87389 |
|
25 |
25 |
$666.70 |
| 86677 |
|
40 |
38 |
$623.24 |
| 77063 |
|
57 |
45 |
$618.22 |
| 84550 |
|
166 |
126 |
$536.52 |
| 86901 |
|
20 |
13 |
$499.45 |
| 84153 |
|
36 |
27 |
$413.31 |
| 86140 |
|
56 |
51 |
$360.44 |
| 87650 |
|
350 |
330 |
$321.00 |
| 82746 |
|
34 |
26 |
$292.18 |
| 76705 |
|
20 |
13 |
$265.00 |
| 94664 |
|
135 |
79 |
$256.22 |
| 73630 |
|
15 |
12 |
$252.00 |
| 82728 |
|
18 |
12 |
$244.40 |
| J2405 |
Ondansetron hcl injection |
242 |
157 |
$244.11 |
| 88175 |
|
17 |
12 |
$207.50 |
| 74000 |
|
14 |
13 |
$190.00 |
| 82570 |
|
29 |
25 |
$171.43 |
| 87210 |
|
31 |
25 |
$154.15 |
| 83550 |
|
15 |
12 |
$137.88 |
| 86885 |
|
17 |
12 |
$116.44 |
| 86900 |
|
19 |
13 |
$56.53 |
| J2550 |
Promethazine hcl injection |
85 |
53 |
$45.32 |
| J2175 |
Meperidine hydrochl /100 mg |
77 |
37 |
$44.15 |
| 93010 |
|
1,975 |
1,325 |
$42.79 |
| J1100 |
Dexamethasone sodium phos |
31 |
25 |
$36.60 |
| 74019 |
|
14 |
12 |
$24.26 |
| J2704 |
Inj, propofol, 10 mg |
19 |
13 |
$16.80 |
| 96361 |
|
28 |
13 |
$12.26 |
| J3490 |
Drugs unclassified injection |
55 |
28 |
$6.65 |
| G0378 |
Hospital observation per hr |
128 |
85 |
$0.00 |
| A4216 |
Sterile water/saline, 10 ml |
22 |
13 |
$0.00 |