| Code | Description | Claims | Beneficiaries | Total Paid |
| 99215 |
Prolong outpt/office vis |
81,301 |
69,041 |
$9.24M |
| 99283 |
|
34,782 |
32,250 |
$7.76M |
| 99214 |
|
78,266 |
67,073 |
$7.75M |
| 99284 |
|
39,531 |
35,202 |
$7.66M |
| 99282 |
|
22,939 |
21,913 |
$5.54M |
| 11042 |
|
8,483 |
3,240 |
$3.79M |
| 90935 |
|
28,642 |
3,294 |
$3.30M |
| 99213 |
|
29,481 |
26,007 |
$2.77M |
| 36415 |
|
109,373 |
58,409 |
$1.85M |
| 97110 |
|
16,997 |
4,745 |
$1.50M |
| J1439 |
Inj ferric carboxymaltos 1mg |
1,301 |
877 |
$1.13M |
| 99205 |
Prolong outpt/office vis |
7,655 |
7,486 |
$1.07M |
| 99285 |
|
6,063 |
5,699 |
$1.04M |
| 80048 |
|
34,329 |
32,823 |
$982K |
| 99204 |
|
7,469 |
7,276 |
$959K |
| U0004 |
Cov-19 test non-cdc hgh thru |
13,541 |
12,860 |
$907K |
| 86850 |
|
14,546 |
13,920 |
$877K |
| 45380 |
|
1,101 |
1,098 |
$853K |
| J0882 |
Darbepoetin alfa, esrd use |
21,539 |
3,624 |
$811K |
| 45378 |
|
830 |
827 |
$770K |
| 96372 |
|
20,947 |
18,508 |
$753K |
| A4657 |
Syringe w/wo needle |
97,439 |
4,391 |
$740K |
| 76856 |
|
5,759 |
5,590 |
$716K |
| 43239 |
|
1,318 |
1,316 |
$707K |
| 99212 |
|
12,700 |
10,365 |
$699K |
| G0378 |
Hospital observation per hr |
857 |
830 |
$687K |
| 80053 |
|
34,269 |
32,110 |
$683K |
| 99391 |
|
8,714 |
8,419 |
$646K |
| 70450 |
|
3,630 |
3,529 |
$622K |
| 87491 |
|
22,618 |
22,359 |
$621K |
| 87536 |
|
7,301 |
7,165 |
$617K |
| 99392 |
|
7,919 |
7,873 |
$558K |
| 58558 |
|
333 |
333 |
$548K |
| 77067 |
|
5,985 |
5,919 |
$513K |
| 99393 |
|
6,551 |
6,505 |
$504K |
| 96365 |
|
3,200 |
1,570 |
$475K |
| 99281 |
|
2,172 |
2,093 |
$468K |
| G0463 |
Hospital outpt clinic visit |
6,861 |
5,386 |
$449K |
| 99402 |
|
5,516 |
4,776 |
$438K |
| 74177 |
|
2,575 |
2,534 |
$405K |
| 86480 |
|
6,860 |
6,798 |
$393K |
| 99396 |
|
4,199 |
4,164 |
$386K |
| 87426 |
|
11,121 |
10,830 |
$359K |
| 90471 |
|
35,182 |
34,603 |
$354K |
| 76816 |
|
5,943 |
5,262 |
$349K |
| 99395 |
|
4,129 |
4,106 |
$347K |
| 88342 |
|
1,177 |
1,170 |
$339K |
| 76830 |
|
5,735 |
5,531 |
$335K |
| 99394 |
|
4,500 |
4,473 |
$320K |
| 90677 |
|
1,843 |
1,808 |
$309K |
| 82306 |
|
15,072 |
15,001 |
$308K |
| 87591 |
|
22,756 |
22,484 |
$297K |
| 96361 |
|
1,999 |
1,714 |
$295K |
| 81025 |
|
13,328 |
12,766 |
$291K |
| 76818 |
|
4,126 |
1,818 |
$270K |
| 80061 |
|
23,713 |
23,553 |
$270K |
| 93306 |
|
2,225 |
2,082 |
$257K |
| 76641 |
|
4,611 |
4,578 |
$255K |
| Q3014 |
Telehealth facility fee |
6,217 |
5,672 |
$242K |
| D1110 |
|
5,740 |
5,726 |
$239K |
| D7140 |
|
4,528 |
3,298 |
$233K |
| 86901 |
|
14,598 |
13,971 |
$227K |
| 83655 |
|
8,100 |
8,061 |
$222K |
| 90460 |
|
10,601 |
10,479 |
$218K |
| G0277 |
Hbot, full body chamber, 30m |
439 |
38 |
$215K |
| 45385 |
|
296 |
296 |
$214K |
| 77066 |
Tomosynthesis, mammo |
2,095 |
2,008 |
$209K |
| 76805 |
|
2,450 |
2,422 |
$205K |
| 85025 |
|
83,286 |
75,293 |
$202K |
| D0330 |
|
6,066 |
5,998 |
$197K |
| 90686 |
|
13,358 |
13,281 |
$186K |
| J1756 |
Iron sucrose injection |
3,292 |
1,258 |
$181K |
| 90670 |
|
6,957 |
6,855 |
$181K |
| 99404 |
|
1,902 |
1,546 |
$178K |
| D0140 |
|
9,631 |
8,869 |
$176K |
| D0120 |
|
6,839 |
6,182 |
$174K |
| 87389 |
|
16,302 |
16,130 |
$170K |
| 88142 |
|
6,034 |
6,001 |
$169K |
| 99381 |
|
1,502 |
1,466 |
$167K |
| 96413 |
|
1,225 |
803 |
$165K |
| 86900 |
|
14,603 |
13,976 |
$163K |
| 88305 |
|
5,393 |
5,312 |
$158K |
| D7210 |
|
1,970 |
1,462 |
$157K |
| 86360 |
|
3,275 |
3,226 |
$154K |
| 82310 |
|
49,648 |
3,555 |
$149K |
| 81003 |
|
24,140 |
22,152 |
$148K |
| 90651 |
|
3,469 |
3,464 |
$145K |
| 76813 |
|
2,236 |
2,213 |
$141K |
| 90715 |
|
5,379 |
5,332 |
$140K |
| 82947 |
|
24,426 |
19,967 |
$138K |
| 76700 |
|
1,287 |
1,271 |
$134K |
| 90750 |
|
857 |
839 |
$132K |
| 93970 |
|
811 |
804 |
$132K |
| 80076 |
|
16,067 |
15,489 |
$131K |
| 81220 |
|
477 |
465 |
$130K |
| 77065 |
Tomosynthesis, mammo |
1,631 |
1,475 |
$127K |
| 76770 |
|
1,044 |
1,041 |
$124K |
| 99442 |
|
1,897 |
1,845 |
$118K |
| 76817 |
|
1,933 |
1,486 |
$118K |
| 74176 |
|
740 |
731 |
$118K |
| J1050 |
Medroxyprogesterone acetate |
1,537 |
1,532 |
$112K |
| 99385 |
|
1,263 |
1,252 |
$111K |
| 19083 |
|
95 |
87 |
$111K |
| C1713 |
Anchor/screw bn/bn,tis/bn |
393 |
383 |
$110K |
| 99203 |
|
1,129 |
1,090 |
$108K |
| 99401 |
|
1,395 |
1,193 |
$108K |
| 90461 |
|
4,601 |
4,560 |
$107K |
| 90472 |
|
10,413 |
10,298 |
$107K |
| 90619 |
|
785 |
779 |
$104K |
| 82728 |
|
9,162 |
8,847 |
$103K |
| 77063 |
|
4,841 |
4,754 |
$103K |
| 76536 |
|
1,448 |
1,445 |
$100K |
| 92250 |
|
2,120 |
2,112 |
$96K |
| 92551 |
|
2,645 |
2,634 |
$95K |
| 86769 |
|
3,246 |
3,119 |
$92K |
| D0150 |
|
3,428 |
3,069 |
$92K |
| 76801 |
|
1,184 |
1,145 |
$91K |
| 71275 |
|
621 |
615 |
$91K |
| 97162 |
|
994 |
991 |
$90K |
| J0606 |
Inj, etelcalcetide, 0.1 mg |
10,561 |
440 |
$90K |
| 76705 |
|
1,886 |
1,873 |
$86K |
| 76811 |
|
992 |
966 |
$84K |
| 83880 |
|
4,742 |
4,594 |
$76K |
| D0274 |
|
3,517 |
3,513 |
$76K |
| 97161 |
|
776 |
772 |
$72K |
| 0001A |
|
2,015 |
2,014 |
$71K |
| 71046 |
|
11,042 |
10,697 |
$70K |
| 88307 |
|
551 |
545 |
$69K |
| D1120 |
|
1,707 |
1,707 |
$68K |
| 83036 |
|
22,984 |
22,802 |
$68K |
| J2916 |
Na ferric gluconate complex |
4,424 |
1,263 |
$67K |
| 0002A |
|
1,826 |
1,826 |
$67K |
| 11045 |
|
230 |
107 |
$67K |
| 83735 |
|
19,092 |
17,590 |
$66K |
| 82607 |
|
5,685 |
5,615 |
$65K |
| 86803 |
|
10,480 |
10,364 |
$64K |
| 96374 |
|
8,271 |
7,625 |
$63K |
| 41899 |
|
50 |
50 |
$63K |
| 86790 |
|
4,541 |
4,507 |
$63K |
| 90746 |
|
1,076 |
1,045 |
$61K |
| D0220 |
|
6,737 |
6,641 |
$59K |
| 84443 |
|
18,566 |
18,198 |
$59K |
| 94726 |
|
762 |
755 |
$57K |
| 76642 |
|
1,441 |
1,369 |
$55K |
| 77062 |
|
1,643 |
1,591 |
$54K |
| 70551 |
|
251 |
249 |
$54K |
| 77061 |
|
984 |
954 |
$53K |
| D2392 |
|
839 |
721 |
$53K |
| D0367 |
|
196 |
196 |
$52K |
| 90682 |
|
1,430 |
1,410 |
$52K |
| 83037 |
|
4,701 |
4,635 |
$52K |
| 90698 |
|
6,649 |
6,574 |
$51K |
| 90680 |
|
5,229 |
5,154 |
$51K |
| 90707 |
|
4,258 |
4,210 |
$51K |
| 73620 |
|
3,254 |
2,263 |
$50K |
| 95115 |
|
1,613 |
1,581 |
$50K |
| 99386 |
|
574 |
573 |
$50K |
| 88341 |
|
434 |
429 |
$49K |
| 99211 |
|
2,015 |
1,957 |
$48K |
| 99173 |
|
2,479 |
2,466 |
$45K |
| 83970 |
|
1,159 |
1,149 |
$45K |
| J1270 |
Injection, doxercalciferol |
12,777 |
1,224 |
$45K |
| 99441 |
|
1,101 |
1,069 |
$42K |
| 93454 |
|
25 |
25 |
$42K |
| 97530 |
|
1,575 |
637 |
$41K |
| D2391 |
|
802 |
677 |
$40K |
| 94010 |
|
551 |
545 |
$40K |
| 82803 |
|
3,036 |
2,913 |
$39K |
| D0230 |
|
4,556 |
4,553 |
$39K |
| 81002 |
|
14,125 |
10,165 |
$39K |
| 86706 |
|
6,926 |
6,816 |
$38K |
| 90633 |
|
3,837 |
3,770 |
$38K |
| 90474 |
|
4,924 |
4,842 |
$36K |
| 97803 |
|
794 |
745 |
$35K |
| 86592 |
|
17,526 |
17,324 |
$35K |
| 0004A |
|
382 |
382 |
$34K |
| 84702 |
|
6,584 |
5,771 |
$32K |
| 83540 |
|
9,261 |
8,956 |
$32K |
| 86704 |
|
5,254 |
5,210 |
$31K |
| 72100 |
|
1,619 |
1,611 |
$31K |
| 97112 |
|
1,230 |
529 |
$29K |
| 84100 |
|
18,802 |
16,986 |
$29K |
| 72148 |
|
120 |
119 |
$29K |
| 96375 |
|
3,951 |
3,333 |
$29K |
| 87340 |
|
10,892 |
10,786 |
$29K |
| 29580 |
|
49 |
24 |
$29K |
| 85610 |
|
19,035 |
17,160 |
$28K |
| 84439 |
|
4,630 |
4,533 |
$28K |
| 83615 |
|
7,139 |
6,532 |
$27K |
| 83550 |
|
8,223 |
7,964 |
$27K |
| 90716 |
|
2,257 |
2,236 |
$26K |
| 90656 |
|
2,110 |
2,107 |
$26K |
| 87480 |
|
2,711 |
2,664 |
$26K |
| 90739 |
|
260 |
257 |
$26K |
| 86762 |
|
2,907 |
2,886 |
$26K |
| 82746 |
|
2,941 |
2,918 |
$25K |
| 90732 |
|
404 |
400 |
$25K |
| 0071A |
|
284 |
284 |
$25K |
| 82784 |
|
1,227 |
1,209 |
$25K |
| 85730 |
|
15,525 |
14,878 |
$25K |
| 94729 |
|
663 |
657 |
$24K |
| 73630 |
|
3,037 |
2,790 |
$24K |
| 73721 |
|
81 |
79 |
$24K |
| D0210 |
|
1,851 |
1,840 |
$24K |
| 87510 |
|
2,714 |
2,672 |
$24K |
| 73610 |
|
2,165 |
2,005 |
$23K |
| 87660 |
|
2,713 |
2,671 |
$23K |
| 73562 |
|
2,135 |
1,996 |
$23K |
| 73030 |
|
1,796 |
1,726 |
$23K |
| 93005 |
|
13,224 |
12,693 |
$22K |
| 81244 |
|
483 |
467 |
$22K |
| 10060 |
|
96 |
95 |
$22K |
| 73130 |
|
2,144 |
2,000 |
$22K |
| 86765 |
|
2,291 |
2,275 |
$21K |
| 84403 |
|
986 |
962 |
$21K |
| 93017 |
|
661 |
658 |
$20K |
| 90697 |
|
2,503 |
2,412 |
$20K |
| 0054A |
|
414 |
414 |
$20K |
| 70486 |
|
263 |
261 |
$19K |
| 88304 |
|
1,300 |
1,287 |
$19K |
| 81508 |
|
908 |
901 |
$19K |
| 90620 |
|
1,344 |
1,337 |
$19K |
| 86334 |
|
1,360 |
1,339 |
$19K |
| 96360 |
|
216 |
209 |
$19K |
| 12011 |
|
54 |
54 |
$19K |
| 87088 |
|
7,351 |
7,122 |
$19K |
| 91320 |
|
206 |
206 |
$18K |
| 87522 |
Neg quan hep c or qual rna |
578 |
573 |
$18K |
| 0072A |
|
262 |
262 |
$18K |
| J1454 |
Inj fosnetupitant, palonoset |
38 |
24 |
$18K |
| 97116 |
|
214 |
180 |
$18K |
| 86709 |
|
2,983 |
2,956 |
$18K |
| 87400 |
|
2,482 |
2,443 |
$17K |
| 86787 |
|
2,529 |
2,510 |
$17K |
| 87070 |
|
2,948 |
2,893 |
$16K |
| 84146 |
|
1,524 |
1,482 |
$16K |
| 20552 |
|
110 |
104 |
$16K |
| 76000 |
|
238 |
233 |
$16K |
| 86695 |
|
1,657 |
1,644 |
$16K |
| 86696 |
|
1,661 |
1,648 |
$16K |
| 90744 |
|
2,562 |
2,550 |
$16K |
| 87635 |
|
485 |
478 |
$16K |
| 82043 |
|
4,159 |
4,131 |
$15K |
| 84550 |
|
5,128 |
4,670 |
$15K |
| D1208 |
|
1,159 |
1,157 |
$15K |
| 72125 |
|
953 |
927 |
$15K |
| 97597 |
|
121 |
94 |
$15K |
| 90688 |
|
2,520 |
2,499 |
$14K |
| 15275 |
|
40 |
36 |
$14K |
| 90734 |
|
1,653 |
1,646 |
$13K |
| 87637 |
|
527 |
521 |
$13K |
| 0052A |
|
240 |
240 |
$13K |
| 85045 |
|
5,114 |
4,829 |
$13K |
| 78452 |
|
49 |
49 |
$13K |
| 97018 |
|
242 |
79 |
$13K |
| D1206 |
|
448 |
444 |
$13K |
| 82378 |
|
627 |
586 |
$13K |
| J0741 |
Inj, cabote rilpivir 2mg 3mg |
13 |
13 |
$12K |
| 95117 |
|
287 |
286 |
$12K |
| 90696 |
|
1,565 |
1,536 |
$12K |
| 87625 |
|
300 |
298 |
$11K |
| 90658 |
|
1,270 |
1,258 |
$11K |
| 96367 |
|
209 |
138 |
$11K |
| 77080 |
|
415 |
405 |
$11K |
| J0561 |
Penicillin g benzathine inj |
165 |
143 |
$11K |
| 83020 |
|
1,196 |
1,174 |
$11K |
| 86735 |
|
1,905 |
1,897 |
$11K |
| 83690 |
|
5,717 |
5,460 |
$11K |
| 84520 |
|
2,718 |
790 |
$11K |
| A9500 |
Tc99m sestamibi |
64 |
63 |
$10K |
| 94640 |
|
3,534 |
3,312 |
$10K |
| 83605 |
|
3,739 |
3,596 |
$10K |
| 73110 |
|
997 |
911 |
$9K |
| 70553 |
|
25 |
25 |
$9K |
| 90673 |
|
184 |
184 |
$9K |
| 71271 |
|
181 |
169 |
$9K |
| 0051A |
|
150 |
150 |
$9K |
| 82550 |
|
1,752 |
1,704 |
$9K |
| 86141 |
|
2,052 |
2,015 |
$9K |
| 91307 |
|
292 |
276 |
$9K |
| 71250 |
|
84 |
84 |
$8K |
| 87186 |
|
1,637 |
1,609 |
$8K |
| 83001 |
|
538 |
537 |
$8K |
| 80320 |
|
1,105 |
1,045 |
$8K |
| 0124A |
|
219 |
219 |
$8K |
| 36430 |
|
56 |
54 |
$8K |
| D4341 |
|
150 |
84 |
$8K |
| 90671 |
|
642 |
641 |
$8K |
| 77049 |
|
26 |
24 |
$8K |
| 84165 |
|
1,504 |
1,479 |
$7K |
| 88112 |
|
149 |
148 |
$7K |
| 80050 |
|
264 |
261 |
$7K |
| 99383 |
|
114 |
113 |
$7K |
| 81511 |
|
238 |
237 |
$7K |
| 99406 |
|
553 |
536 |
$7K |
| 76819 |
|
156 |
140 |
$7K |
| 90480 |
|
232 |
232 |
$7K |
| 90681 |
|
940 |
937 |
$6K |
| 83010 |
|
694 |
690 |
$6K |
| 90740 |
|
56 |
55 |
$6K |
| 83002 |
|
401 |
400 |
$6K |
| 82248 |
|
1,303 |
1,276 |
$6K |
| 83521 |
|
795 |
783 |
$6K |
| 73502 |
|
416 |
396 |
$6K |
| 0003A |
|
68 |
68 |
$5K |
| 81243 |
|
489 |
469 |
$5K |
| 84153 |
|
1,037 |
1,026 |
$5K |
| 84481 |
|
999 |
977 |
$5K |
| 84450 |
|
1,234 |
1,228 |
$5K |
| 71045 |
|
4,365 |
4,197 |
$5K |
| 72050 |
|
161 |
161 |
$5K |
| G0108 |
Diab manage trn per indiv |
85 |
84 |
$5K |
| 90662 |
|
245 |
244 |
$5K |
| 96415 |
|
18 |
12 |
$5K |
| 72131 |
|
51 |
51 |
$5K |
| 82955 |
|
292 |
286 |
$4K |
| 95819 |
|
14 |
14 |
$4K |
| J1200 |
Diphenhydramine hcl injectio |
928 |
734 |
$4K |
| 84460 |
|
1,248 |
1,241 |
$4K |
| 82105 |
|
853 |
844 |
$4K |
| 99384 |
|
61 |
60 |
$4K |
| 72197 |
|
14 |
14 |
$4K |
| J3420 |
Vitamin b12 injection |
2,090 |
1,657 |
$4K |
| 87280 |
|
529 |
520 |
$4K |
| 84480 |
|
1,035 |
1,021 |
$4K |
| 93320 |
|
1,624 |
1,601 |
$4K |
| 86705 |
|
651 |
640 |
$3K |
| 90649 |
|
188 |
184 |
$3K |
| 76820 |
|
176 |
115 |
$3K |
| 0053A |
|
37 |
37 |
$3K |
| 80074 |
|
64 |
63 |
$3K |
| 76870 |
|
50 |
50 |
$3K |
| 97802 |
|
74 |
73 |
$3K |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
1,629 |
1,604 |
$3K |
| 82247 |
|
770 |
674 |
$3K |
| D9243 |
|
28 |
28 |
$3K |
| 97140 |
|
172 |
71 |
$3K |
| 74018 |
|
424 |
417 |
$3K |
| 82570 |
|
905 |
849 |
$2K |
| D9430 |
|
114 |
105 |
$2K |
| 76857 |
|
83 |
82 |
$2K |
| 87624 |
|
85 |
85 |
$2K |
| 85651 |
|
1,857 |
1,827 |
$2K |
| J1100 |
Dexamethasone sodium phos |
4,159 |
3,627 |
$2K |
| 71260 |
|
14 |
14 |
$2K |
| 88313 |
|
1,168 |
1,163 |
$2K |
| D9239 |
|
28 |
28 |
$2K |
| 90685 |
|
362 |
362 |
$2K |
| 86580 |
|
235 |
230 |
$2K |
| 87901 |
|
13 |
13 |
$2K |
| 73080 |
|
232 |
220 |
$2K |
| D0160 |
|
41 |
41 |
$2K |
| 86665 |
|
126 |
125 |
$2K |
| 73564 |
|
74 |
63 |
$2K |
| 82565 |
|
1,028 |
1,020 |
$2K |
| 93325 |
|
1,609 |
1,587 |
$2K |
| Q4150 |
Allowrap ds or dry 1 sq cm |
56 |
56 |
$2K |
| 99443 |
|
31 |
27 |
$1K |
| J7030 |
Normal saline solution infus |
3,932 |
3,772 |
$1K |
| 86777 |
|
135 |
134 |
$1K |
| 86778 |
|
133 |
132 |
$1K |
| 85379 |
|
1,553 |
1,532 |
$1K |
| 84484 |
|
8,058 |
7,698 |
$1K |
| 90473 |
|
180 |
180 |
$1K |
| 73565 |
|
58 |
57 |
$1K |
| 87906 |
|
13 |
13 |
$1K |
| J3490 |
Drugs unclassified injection |
1,044 |
1,012 |
$1K |
| 80307 |
|
70 |
69 |
$1K |
| 87517 |
|
29 |
29 |
$1K |
| 90733 |
|
59 |
59 |
$1K |
| 0031A |
|
27 |
27 |
$1K |
| C1769 |
Guide wire |
112 |
104 |
$1K |
| 76821 |
|
17 |
13 |
$992.75 |
| 73590 |
|
240 |
231 |
$977.70 |
| D0272 |
|
77 |
77 |
$972.21 |
| 93971 |
|
12 |
12 |
$916.35 |
| 84425 |
|
64 |
63 |
$865.76 |
| 97165 |
|
12 |
12 |
$849.58 |
| 93923 |
|
14 |
14 |
$833.25 |
| Q0144 |
Azithromycin dihydrate, oral |
180 |
169 |
$826.12 |
| D0270 |
|
98 |
98 |
$816.16 |
| J3010 |
Fentanyl citrate injection |
1,544 |
1,527 |
$800.48 |
| 84132 |
|
718 |
711 |
$763.85 |
| 86003 |
|
138 |
138 |
$619.03 |
| 85384 |
|
265 |
254 |
$595.21 |
| 86038 |
|
157 |
157 |
$595.18 |
| J1885 |
Ketorolac tromethamine inj |
11,203 |
10,558 |
$574.00 |
| 87900 |
|
13 |
13 |
$560.00 |
| J7050 |
Normal saline solution infus |
711 |
491 |
$504.15 |
| 86780 |
|
77 |
77 |
$503.92 |
| 99382 |
|
13 |
13 |
$488.00 |
| 88311 |
|
166 |
166 |
$487.21 |
| D9310 |
|
12 |
12 |
$450.69 |
| 74019 |
|
66 |
66 |
$437.92 |
| 99001 |
|
733 |
646 |
$431.49 |
| 90687 |
|
17 |
17 |
$426.42 |
| 81000 |
|
140 |
107 |
$384.00 |
| 99202 |
|
12 |
12 |
$383.52 |
| 87040 |
|
664 |
638 |
$328.11 |
| 84466 |
|
593 |
590 |
$323.95 |
| 82040 |
|
603 |
599 |
$318.14 |
| 82150 |
|
146 |
142 |
$314.56 |
| 87338 |
|
255 |
254 |
$295.17 |
| 90660 |
|
50 |
50 |
$285.60 |
| J0558 |
Peng benzathine/procaine inj |
14 |
14 |
$273.24 |
| 96127 |
|
47 |
47 |
$239.09 |
| 86870 |
|
12 |
12 |
$221.93 |
| D1330 |
|
94 |
90 |
$212.47 |
| 90647 |
|
41 |
41 |
$196.35 |
| 80329 |
|
433 |
221 |
$192.89 |
| 84436 |
|
187 |
178 |
$180.63 |
| 90723 |
|
43 |
42 |
$178.50 |
| 86593 |
|
77 |
77 |
$173.51 |
| 73140 |
|
31 |
29 |
$164.90 |
| 86304 |
|
27 |
26 |
$156.24 |
| J2765 |
Metoclopramide hcl injection |
1,727 |
1,647 |
$152.88 |
| 84075 |
|
600 |
597 |
$151.77 |
| J2270 |
Morphine sulfate injection |
127 |
123 |
$151.70 |
| 83883 |
|
14 |
12 |
$149.58 |
| 82533 |
|
29 |
25 |
$146.70 |
| 73090 |
|
72 |
67 |
$138.96 |
| 82108 |
|
137 |
137 |
$136.09 |
| J0696 |
Ceftriaxone sodium injection |
751 |
719 |
$126.46 |
| 82668 |
|
13 |
13 |
$125.10 |
| 82374 |
|
578 |
575 |
$116.82 |
| 86880 |
|
12 |
12 |
$114.99 |
| 84295 |
|
584 |
580 |
$114.65 |
| G0008 |
Admin influenza virus vac |
153 |
151 |
$114.53 |
| 80069 |
|
15 |
15 |
$112.84 |
| 82435 |
|
582 |
578 |
$110.08 |
| 86677 |
|
15 |
14 |
$96.36 |
| 84155 |
|
581 |
578 |
$96.24 |
| 90700 |
|
13 |
13 |
$89.25 |
| 99152 |
|
183 |
178 |
$83.45 |
| 87110 |
|
76 |
75 |
$80.12 |
| 82977 |
|
20 |
20 |
$73.39 |
| 86301 |
|
14 |
12 |
$73.00 |
| 90380 |
|
18 |
18 |
$71.51 |
| 90648 |
|
13 |
13 |
$71.40 |
| 82553 |
|
527 |
515 |
$63.20 |
| 83721 |
|
77 |
76 |
$55.38 |
| 86430 |
|
13 |
13 |
$44.37 |
| J3475 |
Inj magnesium sulfate |
46 |
42 |
$13.47 |
| Q0162 |
Ondansetron oral |
98 |
95 |
$11.81 |
| J0690 |
Cefazolin sodium injection |
66 |
65 |
$4.57 |
| G1004 |
Cdsm ndsc |
2,381 |
2,346 |
$1.34 |
| J7512 |
Prednisone ir or dr oral 1mg |
165 |
157 |
$1.00 |
| J8597 |
Antiemetic drug oral nos |
48 |
48 |
$0.34 |
| 99429 |
|
156 |
120 |
$0.00 |
| J8540 |
Oral dexamethasone |
12 |
12 |
$0.00 |
| 96376 |
|
13 |
13 |
$0.00 |
| 99080 |
|
3,389 |
1,012 |
$0.00 |
| A4649 |
Surgical supplies |
236 |
236 |
$0.00 |
| C9113 |
Inj pantoprazole sodium, via |
165 |
161 |
$0.00 |
| Q0163 |
Diphenhydramine hcl 50mg |
13 |
13 |
$0.00 |
| 82948 |
|
13 |
13 |
$0.00 |
| C1760 |
Closure dev, vasc |
13 |
13 |
$0.00 |
| J7510 |
Prednisolone oral per 5 mg |
14 |
14 |
$0.00 |