| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99284 |
|
68,064 |
66,002 |
$2.39M |
| 99285 |
|
20,963 |
20,470 |
$1.70M |
| 99213 |
|
170,187 |
157,558 |
$1.45M |
| 99283 |
|
41,620 |
40,100 |
$977K |
| 74177 |
|
11,731 |
11,526 |
$647K |
| 91320 |
|
3,801 |
3,800 |
$619K |
| 99214 |
|
68,057 |
64,078 |
$478K |
| 99281 |
|
20,876 |
19,869 |
$472K |
| 70450 |
|
12,820 |
12,458 |
$392K |
| 90480 |
|
6,803 |
6,796 |
$329K |
| 92012 |
|
26,520 |
25,884 |
$282K |
| 93010 |
|
57,747 |
52,006 |
$272K |
| 88305 |
|
27,759 |
24,685 |
$264K |
| 77067 |
|
18,454 |
14,145 |
$261K |
| 0002A |
|
5,891 |
5,890 |
$229K |
| 0001A |
|
6,219 |
6,219 |
$228K |
| 99212 |
|
65,262 |
60,839 |
$191K |
| 71045 |
|
42,696 |
38,470 |
$178K |
| 90962 |
|
2,168 |
2,113 |
$165K |
| G0008 |
Admin influenza virus vac |
8,410 |
8,405 |
$164K |
| 99282 |
|
17,896 |
17,521 |
$152K |
| U0003 |
Cov-19 amp prb hgh thruput |
60,593 |
49,757 |
$142K |
| J0585 |
Injection,onabotulinumtoxina |
417 |
253 |
$116K |
| 70551 |
|
2,993 |
2,883 |
$112K |
| 0004A |
|
2,676 |
2,676 |
$106K |
| 74176 |
|
2,261 |
2,217 |
$100K |
| 87637 |
|
710 |
653 |
$98K |
| 92015 |
|
44,695 |
44,318 |
$90K |
| 99215 |
Prolong outpt/office vis |
3,828 |
3,707 |
$88K |
| 93306 |
|
2,928 |
2,299 |
$84K |
| 0012A |
|
2,068 |
2,068 |
$78K |
| 71046 |
|
22,029 |
18,303 |
$77K |
| 0064A |
|
1,895 |
1,895 |
$75K |
| 0011A |
|
2,289 |
2,289 |
$74K |
| 0124A |
|
2,005 |
2,005 |
$71K |
| 0071A |
|
1,768 |
1,768 |
$70K |
| 0072A |
|
1,702 |
1,702 |
$68K |
| 90837 |
|
6,780 |
4,918 |
$65K |
| 87491 |
|
38,504 |
36,163 |
$57K |
| 87591 |
|
38,496 |
36,159 |
$57K |
| 90662 |
|
4,835 |
4,829 |
$56K |
| 96374 |
|
1,787 |
1,396 |
$53K |
| 90686 |
|
62,946 |
62,547 |
$52K |
| 92250 |
|
7,910 |
7,804 |
$50K |
| 92002 |
|
9,765 |
9,725 |
$49K |
| 85025 |
|
61,841 |
58,169 |
$46K |
| 93005 |
|
4,213 |
4,085 |
$43K |
| 90656 |
|
5,930 |
5,923 |
$42K |
| 71275 |
|
319 |
318 |
$41K |
| 0054A |
|
1,051 |
1,051 |
$41K |
| 92507 |
|
17,073 |
5,201 |
$39K |
| 76815 |
|
5,609 |
3,392 |
$38K |
| 99392 |
|
11,216 |
11,066 |
$36K |
| 72148 |
|
1,856 |
1,753 |
$35K |
| 80051 |
|
26,046 |
24,178 |
$35K |
| 87635 |
|
2,098 |
1,847 |
$34K |
| 90651 |
|
6,090 |
6,088 |
$34K |
| 76705 |
|
4,857 |
4,746 |
$34K |
| 99203 |
|
9,341 |
9,169 |
$32K |
| 97810 |
|
3,306 |
2,802 |
$31K |
| 99393 |
|
8,464 |
8,445 |
$31K |
| 99442 |
|
372 |
334 |
$30K |
| 90834 |
|
12,807 |
9,535 |
$29K |
| 90791 |
|
4,477 |
4,360 |
$28K |
| 71260 |
|
1,875 |
1,809 |
$28K |
| 91322 |
|
156 |
156 |
$28K |
| 82565 |
|
106,635 |
101,162 |
$28K |
| 96375 |
|
747 |
670 |
$26K |
| 90471 |
|
46,952 |
45,838 |
$26K |
| 99443 |
|
219 |
216 |
$26K |
| 0134A |
|
691 |
691 |
$25K |
| 97811 |
|
2,908 |
2,520 |
$24K |
| 99394 |
|
5,898 |
5,894 |
$23K |
| 99202 |
|
12,232 |
11,934 |
$22K |
| 80307 |
|
9,117 |
8,678 |
$22K |
| 73630 |
|
7,784 |
5,364 |
$22K |
| 87631 |
|
2,254 |
2,229 |
$22K |
| 99391 |
|
4,339 |
4,260 |
$21K |
| T4530 |
Ped size brief/diaper lg |
1,436 |
1,387 |
$21K |
| 90670 |
|
5,215 |
5,169 |
$21K |
| A0427 |
Als1-emergency |
6,165 |
5,603 |
$20K |
| 96372 |
|
9,625 |
7,748 |
$20K |
| 73721 |
|
1,431 |
1,268 |
$20K |
| 90653 |
|
364 |
364 |
$20K |
| J3490 |
Drugs unclassified injection |
2,467 |
1,188 |
$19K |
| 99232 |
|
4,981 |
1,480 |
$19K |
| 92523 |
|
405 |
396 |
$19K |
| 82947 |
|
40,347 |
38,523 |
$19K |
| 84520 |
|
33,276 |
30,933 |
$19K |
| 72125 |
|
585 |
578 |
$19K |
| E1390 |
Oxygen concentrator |
7,534 |
7,518 |
$18K |
| 0031A |
|
456 |
456 |
$17K |
| 84443 |
|
74,522 |
73,051 |
$17K |
| 87651 |
|
13,903 |
13,638 |
$17K |
| 82306 |
|
18,116 |
17,918 |
$17K |
| 99441 |
|
339 |
327 |
$16K |
| 64615 |
|
415 |
415 |
$16K |
| 86580 |
|
13,122 |
12,451 |
$16K |
| 84460 |
|
83,098 |
80,094 |
$16K |
| 97530 |
|
4,906 |
2,833 |
$16K |
| J7030 |
Normal saline solution infus |
1,748 |
1,425 |
$16K |
| 70553 |
|
699 |
638 |
$15K |
| 77080 |
|
2,154 |
2,018 |
$15K |
| 91319 |
|
286 |
286 |
$15K |
| 87506 |
|
2,416 |
2,392 |
$15K |
| 90853 |
|
14,796 |
7,195 |
$15K |
| 90734 |
|
4,345 |
4,345 |
$14K |
| 83690 |
|
7,386 |
7,157 |
$14K |
| 90710 |
|
3,562 |
3,553 |
$14K |
| 84450 |
|
34,414 |
32,604 |
$13K |
| 82247 |
|
20,392 |
18,981 |
$13K |
| A4232 |
Syringe w/needle insulin 3cc |
656 |
651 |
$12K |
| 98968 |
|
1,902 |
1,738 |
$12K |
| 92557 |
|
1,593 |
1,585 |
$12K |
| 92134 |
|
1,677 |
1,607 |
$11K |
| 96365 |
|
1,655 |
1,062 |
$11K |
| 67028 |
|
861 |
750 |
$11K |
| T4522 |
Adult size brief/diaper med |
2,716 |
2,636 |
$11K |
| 0073A |
|
282 |
282 |
$11K |
| A0425 |
Ground mileage |
11,119 |
8,215 |
$11K |
| 96361 |
|
358 |
317 |
$11K |
| 76830 |
|
2,802 |
2,720 |
$11K |
| 99201 |
|
8,807 |
8,568 |
$10K |
| B4035 |
Enteral feed supp pump per d |
434 |
426 |
$10K |
| 97802 |
|
367 |
365 |
$10K |
| A4230 |
Infus insulin pump non needl |
235 |
234 |
$9K |
| 92567 |
|
368 |
368 |
$9K |
| 84075 |
|
19,619 |
18,412 |
$9K |
| 0154A |
|
259 |
259 |
$9K |
| 80306 |
|
444 |
429 |
$9K |
| 90677 |
|
181 |
174 |
$9K |
| 73221 |
|
607 |
545 |
$8K |
| E0570 |
Nebulizer with compression |
1,735 |
1,712 |
$8K |
| 0052A |
|
206 |
206 |
$8K |
| J0131 |
Inj, acetaminophen (nos) |
220 |
194 |
$8K |
| J1885 |
Ketorolac tromethamine inj |
2,290 |
2,117 |
$8K |
| 88342 |
|
4,084 |
3,570 |
$8K |
| K0001 |
Standard wheelchair |
6,467 |
6,456 |
$8K |
| E0601 |
Cont airway pressure device |
1,604 |
1,601 |
$8K |
| 73610 |
|
4,332 |
3,242 |
$8K |
| 92014 |
|
1,573 |
1,545 |
$7K |
| 99308 |
|
81 |
80 |
$7K |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
510 |
496 |
$7K |
| 76856 |
|
2,152 |
2,068 |
$7K |
| 90847 |
|
167 |
157 |
$7K |
| 99211 |
|
11,920 |
11,328 |
$7K |
| 0051A |
|
170 |
170 |
$7K |
| T4534 |
Youth size pull-on |
2,158 |
2,069 |
$7K |
| 0081A |
|
165 |
165 |
$6K |
| 90472 |
|
2,928 |
2,797 |
$6K |
| T4525 |
Adult size pull-on sm |
1,357 |
1,315 |
$6K |
| 97110 |
|
8,724 |
6,819 |
$6K |
| 72141 |
|
852 |
777 |
$6K |
| 83735 |
|
14,720 |
13,060 |
$6K |
| 84439 |
|
12,813 |
12,162 |
$6K |
| 73030 |
|
2,933 |
2,127 |
$6K |
| 95117 |
|
3,369 |
1,692 |
$6K |
| B9002 |
Enter nutr inf pump any type |
471 |
466 |
$6K |
| H0032 |
Mh svc plan dev by non-md |
883 |
357 |
$6K |
| 73130 |
|
2,968 |
1,977 |
$6K |
| 83970 |
|
5,186 |
5,070 |
$6K |
| 90682 |
|
5,948 |
5,945 |
$6K |
| 87636 |
|
2,719 |
1,684 |
$6K |
| 90715 |
|
5,924 |
5,923 |
$5K |
| 87088 |
|
28,094 |
26,470 |
$5K |
| 81001 |
|
1,560 |
1,459 |
$5K |
| 82728 |
|
37,004 |
36,152 |
$5K |
| 83036 |
|
93,276 |
92,514 |
$5K |
| 88341 |
|
1,975 |
1,674 |
$5K |
| A0429 |
Bls-emergency |
2,010 |
1,823 |
$5K |
| E0562 |
Humidifier heated used w pap |
1,918 |
1,906 |
$5K |
| 0082A |
|
136 |
136 |
$5K |
| Q5103 |
Injection, inflectra |
259 |
231 |
$5K |
| 99233 |
Prolong inpt eval add15 m |
2,992 |
757 |
$5K |
| E0471 |
Rad w/backup non inv intrfc |
250 |
250 |
$5K |
| 70486 |
|
459 |
442 |
$5K |
| J2405 |
Ondansetron hcl injection |
902 |
784 |
$5K |
| E0600 |
Suction pump portab hom modl |
473 |
463 |
$5K |
| U0004 |
Cov-19 test non-cdc hgh thru |
3,021 |
1,973 |
$5K |
| 70491 |
|
367 |
352 |
$4K |
| 91318 |
|
212 |
208 |
$4K |
| 74018 |
|
2,085 |
1,630 |
$4K |
| B4034 |
Enter feed supkit syr by day |
573 |
566 |
$4K |
| 86235 |
|
2,024 |
2,004 |
$4K |
| 87798 |
|
469 |
458 |
$4K |
| 94660 |
|
680 |
678 |
$4K |
| 80061 |
|
51,744 |
51,376 |
$4K |
| 86003 |
|
2,992 |
2,939 |
$4K |
| 82077 |
|
236 |
228 |
$4K |
| 83516 |
|
4,943 |
4,913 |
$4K |
| 73110 |
|
2,474 |
1,744 |
$4K |
| 90792 |
|
1,661 |
1,630 |
$4K |
| 76770 |
|
1,019 |
993 |
$4K |
| 76642 |
|
1,089 |
950 |
$4K |
| 90723 |
|
2,606 |
2,595 |
$4K |
| G2012 |
Brief check in by md/qhp |
6,823 |
6,595 |
$4K |
| 99222 |
|
40 |
40 |
$4K |
| 95800 |
|
14 |
14 |
$3K |
| T4526 |
Adult size pull-on med |
8,723 |
8,468 |
$3K |
| 90833 |
|
1,865 |
1,422 |
$3K |
| 85027 |
|
51,927 |
50,970 |
$3K |
| 90648 |
|
4,544 |
4,508 |
$3K |
| 0003A |
|
76 |
76 |
$3K |
| 73564 |
|
3,097 |
1,873 |
$3K |
| 72100 |
|
2,390 |
1,876 |
$3K |
| 87502 |
|
1,726 |
1,686 |
$3K |
| 99204 |
|
1,720 |
1,691 |
$3K |
| J7999 |
Compounded drug, noc |
59 |
58 |
$3K |
| 97140 |
|
5,243 |
3,818 |
$3K |
| 73560 |
|
2,390 |
1,505 |
$3K |
| 92526 |
|
188 |
78 |
$3K |
| 87389 |
|
23,065 |
22,873 |
$3K |
| 93976 |
|
318 |
314 |
$3K |
| 87040 |
|
943 |
807 |
$3K |
| 90633 |
|
3,779 |
3,754 |
$3K |
| T4527 |
Adult size pull-on lg |
8,736 |
8,469 |
$3K |
| 99205 |
Prolong outpt/office vis |
953 |
927 |
$3K |
| 80048 |
|
5,214 |
4,853 |
$3K |
| 84484 |
|
191 |
179 |
$2K |
| 99070 |
|
101 |
82 |
$2K |
| 84403 |
|
4,231 |
4,147 |
$2K |
| 93971 |
|
619 |
608 |
$2K |
| 86140 |
|
13,267 |
12,799 |
$2K |
| E0431 |
Portable gaseous 02 |
2,258 |
2,252 |
$2K |
| 93000 |
|
930 |
920 |
$2K |
| 83550 |
|
19,201 |
18,807 |
$2K |
| 93303 |
|
42 |
36 |
$2K |
| 73502 |
|
1,296 |
1,011 |
$2K |
| 86360 |
|
1,337 |
1,316 |
$2K |
| 97597 |
|
482 |
440 |
$2K |
| K0738 |
Portable gas oxygen system |
3,774 |
3,762 |
$2K |
| 80197 |
|
2,068 |
1,466 |
$2K |
| 83655 |
|
6,115 |
5,896 |
$2K |
| 92004 |
|
794 |
792 |
$2K |
| 84100 |
|
8,683 |
8,006 |
$2K |
| 88720 |
|
2,833 |
2,036 |
$2K |
| 90885 |
|
2,521 |
907 |
$2K |
| K0006 |
Heavy duty wheelchair |
396 |
396 |
$2K |
| 81003 |
|
824 |
792 |
$2K |
| 73080 |
|
1,211 |
852 |
$2K |
| 74022 |
|
622 |
594 |
$2K |
| E0143 |
Walker folding wheeled w/o s |
2,501 |
2,472 |
$2K |
| A0428 |
Bls |
3,413 |
2,580 |
$2K |
| 85610 |
|
16,853 |
14,395 |
$2K |
| J0696 |
Ceftriaxone sodium injection |
628 |
496 |
$2K |
| 86665 |
|
1,403 |
1,392 |
$2K |
| 83540 |
|
19,508 |
19,111 |
$2K |
| H0004 |
Alcohol and/or drug services |
3,933 |
2,184 |
$2K |
| 11721 |
|
704 |
686 |
$2K |
| 0111A |
|
70 |
70 |
$2K |
| 73562 |
|
1,323 |
787 |
$2K |
| 82570 |
|
12,462 |
11,699 |
$2K |
| 0112A |
|
68 |
68 |
$2K |
| 99152 |
|
419 |
410 |
$2K |
| 73590 |
|
1,003 |
722 |
$2K |
| 90681 |
|
976 |
976 |
$2K |
| 96360 |
|
113 |
66 |
$2K |
| T4523 |
Adult size brief/diaper lg |
2,237 |
2,166 |
$2K |
| 93970 |
|
197 |
188 |
$2K |
| 72040 |
|
1,230 |
967 |
$1K |
| 82248 |
|
5,169 |
4,786 |
$1K |
| 20610 |
|
1,374 |
1,255 |
$1K |
| A0130 |
Noner transport wheelch van |
17,488 |
3,636 |
$1K |
| 80069 |
|
1,724 |
1,589 |
$1K |
| 86160 |
|
1,660 |
1,496 |
$1K |
| J1100 |
Dexamethasone sodium phos |
561 |
505 |
$1K |
| 76805 |
|
685 |
531 |
$1K |
| 90696 |
|
1,992 |
1,991 |
$1K |
| 86803 |
|
19,477 |
19,338 |
$1K |
| 82977 |
|
1,607 |
1,501 |
$1K |
| 73140 |
|
1,854 |
1,289 |
$1K |
| 86480 |
|
2,608 |
2,590 |
$1K |
| 72170 |
|
472 |
399 |
$1K |
| 99291 |
|
345 |
199 |
$1K |
| 83020 |
|
1,742 |
1,713 |
$1K |
| A6402 |
Sterile gauze <= 16 sq in |
166 |
157 |
$1K |
| 82784 |
|
2,568 |
2,399 |
$1K |
| E0277 |
Powered pres-redu air mattrs |
351 |
349 |
$1K |
| 84156 |
|
11,066 |
10,344 |
$1K |
| 94640 |
|
493 |
457 |
$1K |
| K0003 |
Lightweight wheelchair |
1,101 |
1,101 |
$1K |
| 87070 |
|
4,643 |
4,367 |
$1K |
| 87426 |
|
1,380 |
692 |
$1K |
| 90832 |
|
2,158 |
1,954 |
$1K |
| 71250 |
|
583 |
553 |
$1K |
| 82310 |
|
14,364 |
13,786 |
$1K |
| 73090 |
|
766 |
553 |
$1K |
| 94729 |
|
783 |
782 |
$1K |
| T4541 |
Large disposable underpad |
17,461 |
16,915 |
$1K |
| 0013A |
|
27 |
27 |
$1K |
| 83993 |
|
1,010 |
988 |
$1K |
| 90716 |
|
520 |
519 |
$1K |
| 82040 |
|
11,131 |
10,663 |
$1K |
| 90674 |
|
1,709 |
1,706 |
$1K |
| 96366 |
|
131 |
93 |
$1K |
| 97166 |
|
24 |
24 |
$994.00 |
| 91321 |
|
21 |
21 |
$980.00 |
| 87209 |
|
2,366 |
2,332 |
$965.91 |
| 99238 |
|
1,102 |
938 |
$955.32 |
| J7120 |
Ringers lactate infusion |
100 |
93 |
$953.70 |
| 99385 |
|
1,097 |
1,088 |
$952.74 |
| L2820 |
Soft interface below knee se |
25 |
25 |
$945.42 |
| 74019 |
|
925 |
728 |
$930.01 |
| 93325 |
|
30 |
25 |
$919.00 |
| 82607 |
|
14,613 |
14,522 |
$895.61 |
| E0630 |
Patient lift hydraulic |
828 |
828 |
$881.77 |
| 90700 |
|
1,682 |
1,682 |
$851.02 |
| E0443 |
Portable 02 contents, gas |
96 |
96 |
$849.38 |
| E0185 |
Gel pressure mattress pad |
496 |
490 |
$834.29 |
| 97112 |
|
463 |
401 |
$833.89 |
| 82043 |
|
19,345 |
19,211 |
$832.94 |
| 93320 |
|
29 |
24 |
$826.96 |
| G2023 |
Specimen collect covid-19 |
6,295 |
3,136 |
$821.10 |
| 86780 |
|
22,639 |
22,428 |
$808.65 |
| 76817 |
|
288 |
263 |
$807.90 |
| 80164 |
|
1,378 |
1,325 |
$807.49 |
| T4528 |
Adult size pull-on xl |
6,143 |
5,931 |
$803.88 |
| 86664 |
|
1,403 |
1,392 |
$779.76 |
| 86706 |
|
7,507 |
7,431 |
$778.49 |
| 90707 |
|
685 |
685 |
$773.26 |
| 92579 |
|
206 |
205 |
$772.71 |
| 0083A |
|
28 |
28 |
$751.00 |
| 96413 |
|
1,629 |
1,201 |
$750.09 |
| 76536 |
|
463 |
438 |
$734.28 |
| 82746 |
|
2,582 |
2,573 |
$710.36 |
| 84146 |
|
2,638 |
2,591 |
$706.97 |
| D1206 |
|
905 |
903 |
$700.20 |
| 77066 |
Tomosynthesis, mammo |
367 |
347 |
$700.00 |
| 87529 |
|
1,559 |
1,540 |
$695.64 |
| 84702 |
|
1,941 |
1,619 |
$688.39 |
| 90694 |
|
1,050 |
1,050 |
$684.42 |
| 99223 |
Prolong inpt eval add15 m |
481 |
410 |
$682.59 |
| 82550 |
|
3,749 |
3,585 |
$674.44 |
| 76870 |
|
190 |
184 |
$652.35 |
| 71101 |
|
303 |
251 |
$644.33 |
| 10060 |
|
354 |
347 |
$643.31 |
| E0181 |
Press pad alternating w/ pum |
776 |
775 |
$633.52 |
| 87340 |
|
16,633 |
16,482 |
$626.10 |
| 73552 |
|
268 |
211 |
$613.93 |
| 77065 |
Tomosynthesis, mammo |
419 |
369 |
$612.77 |
| 82150 |
|
2,542 |
2,488 |
$594.87 |
| 86225 |
|
2,159 |
2,136 |
$593.99 |
| E0603 |
Electric breast pump |
1,578 |
1,574 |
$591.50 |
| 94010 |
|
431 |
427 |
$569.49 |
| 82670 |
|
1,570 |
1,524 |
$567.33 |
| 81025 |
|
11,997 |
11,496 |
$557.40 |
| 90658 |
|
991 |
988 |
$553.20 |
| 86901 |
|
4,036 |
3,997 |
$547.17 |
| 88307 |
|
560 |
492 |
$541.00 |
| 59025 |
|
1,822 |
1,042 |
$530.86 |
| 86900 |
|
4,013 |
3,974 |
$526.81 |
| 87329 |
|
2,313 |
2,280 |
$497.60 |
| 83498 |
|
541 |
537 |
$491.53 |
| 82533 |
|
930 |
854 |
$479.21 |
| 90661 |
|
144 |
143 |
$476.75 |
| 82627 |
|
862 |
861 |
$463.52 |
| T4521 |
Adult size brief/diaper sm |
26 |
26 |
$462.63 |
| 94726 |
|
387 |
359 |
$461.66 |
| 66984 |
|
251 |
226 |
$447.52 |
| 73522 |
|
300 |
221 |
$445.67 |
| 72070 |
|
600 |
485 |
$436.86 |
| 84480 |
|
1,504 |
1,408 |
$433.16 |
| G0480 |
Drug test def 1-7 classes |
1,798 |
1,729 |
$431.65 |
| 97804 |
|
30 |
29 |
$431.07 |
| 84550 |
|
8,457 |
8,256 |
$418.11 |
| 12001 |
|
203 |
203 |
$410.36 |
| 73600 |
|
542 |
415 |
$405.72 |
| J1200 |
Diphenhydramine hcl injectio |
305 |
207 |
$400.99 |
| 87081 |
|
3,717 |
3,699 |
$399.04 |
| 73060 |
|
215 |
170 |
$391.41 |
| 99231 |
|
735 |
375 |
$388.77 |
| 73620 |
|
702 |
452 |
$388.56 |
| 86038 |
|
2,503 |
2,487 |
$382.63 |
| 73660 |
|
489 |
372 |
$382.29 |
| 84132 |
|
52,011 |
50,504 |
$371.82 |
| 93225 |
|
364 |
353 |
$371.18 |
| T4535 |
Disposable liner/shield/pad |
16,669 |
15,911 |
$370.26 |
| 73100 |
|
715 |
401 |
$367.95 |
| 76775 |
|
215 |
210 |
$367.79 |
| 92133 |
|
871 |
868 |
$367.66 |
| 86704 |
|
4,967 |
4,905 |
$367.20 |
| 83002 |
|
1,380 |
1,358 |
$357.39 |
| 92587 |
|
26 |
26 |
$356.70 |
| 82962 |
|
57 |
39 |
$348.40 |
| 90732 |
|
1,600 |
1,600 |
$343.09 |
| 92504 |
|
395 |
369 |
$339.67 |
| J1050 |
Medroxyprogesterone acetate |
1,783 |
1,743 |
$333.96 |
| 99221 |
|
369 |
329 |
$332.47 |
| 90785 |
|
40 |
39 |
$330.00 |
| 86850 |
|
3,112 |
3,085 |
$329.81 |
| 87102 |
|
3,850 |
3,748 |
$326.86 |
| 88304 |
|
1,874 |
1,606 |
$320.09 |
| 94060 |
|
487 |
477 |
$318.79 |
| 87624 |
|
21,364 |
21,355 |
$315.20 |
| 77063 |
|
19 |
14 |
$315.00 |
| E1038 |
Transport chair pt wt<=300lb |
1,586 |
1,583 |
$313.04 |
| 90691 |
|
518 |
518 |
$312.81 |
| 85014 |
|
6,737 |
6,471 |
$311.72 |
| 97162 |
|
13 |
13 |
$308.00 |
| 84295 |
|
26,276 |
25,500 |
$294.69 |
| 87536 |
|
1,059 |
1,043 |
$294.30 |
| 98966 |
|
27 |
27 |
$288.60 |
| 83001 |
|
2,632 |
2,613 |
$278.23 |
| 90744 |
|
328 |
328 |
$277.68 |
| B4088 |
Gastro/jejuno tube, low-pro |
119 |
118 |
$274.70 |
| 83615 |
|
2,092 |
1,937 |
$268.25 |
| G9008 |
Mccd,phys coor-care ovrsght |
1,475 |
1,000 |
$260.00 |
| 82105 |
|
1,569 |
1,519 |
$258.04 |
| T4524 |
Adult size brief/diaper xl |
2,129 |
2,039 |
$257.30 |
| 85045 |
|
1,998 |
1,930 |
$252.42 |
| 70496 |
|
13 |
13 |
$249.54 |
| 76000 |
|
267 |
261 |
$248.66 |
| K0007 |
Extra heavy duty wheelchair |
383 |
382 |
$245.08 |
| 85007 |
|
470 |
452 |
$241.06 |
| J2270 |
Morphine sulfate injection |
30 |
27 |
$230.03 |
| 86328 |
|
269 |
207 |
$226.15 |
| 45378 |
|
168 |
167 |
$223.74 |
| A0170 |
Transport parking fees/tolls |
33,949 |
5,005 |
$222.93 |
| 93041 |
|
1,453 |
1,351 |
$222.39 |
| 85018 |
|
6,675 |
6,443 |
$207.21 |
| 88313 |
|
117 |
91 |
$205.92 |
| 74183 |
|
68 |
68 |
$204.50 |
| 69210 |
|
175 |
173 |
$193.87 |
| 92083 |
|
720 |
713 |
$193.74 |
| 99153 |
Mod sedat endo service >5yrs |
99 |
98 |
$187.16 |
| A5120 |
Skin barrier, wipe or swab |
74 |
71 |
$184.75 |
| 90713 |
|
336 |
336 |
$183.07 |
| 83605 |
|
14 |
13 |
$180.44 |
| 84134 |
|
245 |
240 |
$178.06 |
| 96112 |
|
13 |
13 |
$173.11 |
| 72050 |
|
163 |
133 |
$169.81 |
| 73120 |
|
366 |
246 |
$169.34 |
| J3301 |
Triamcinolone acet inj nos |
482 |
470 |
$163.86 |
| 83721 |
|
4,500 |
4,486 |
$159.48 |
| 88142 |
|
15,626 |
15,616 |
$157.64 |
| 96415 |
|
634 |
522 |
$150.43 |
| 87210 |
|
3,547 |
3,417 |
$149.92 |
| E0163 |
Commode chair with fixed arm |
731 |
729 |
$146.62 |
| 73070 |
|
92 |
54 |
$144.78 |
| 86787 |
|
2,036 |
2,025 |
$142.36 |
| 76376 |
|
12 |
12 |
$140.00 |
| 43239 |
|
661 |
658 |
$139.85 |
| 88312 |
|
1,521 |
1,233 |
$135.61 |
| A7030 |
Cpap full face mask |
2,056 |
2,033 |
$135.14 |
| E1392 |
Portable oxygen concentrator |
2,061 |
2,061 |
$133.71 |
| 86762 |
|
4,141 |
4,126 |
$130.07 |
| K0739 |
Repair/svc dme non-oxygen eq |
507 |
482 |
$130.00 |
| 93015 |
|
69 |
60 |
$129.48 |
| J2930 |
Methylprednisolone injection |
139 |
103 |
$129.08 |
| 86376 |
|
555 |
553 |
$122.44 |
| 84630 |
|
662 |
657 |
$119.00 |
| 86677 |
|
642 |
641 |
$118.69 |
| 97116 |
|
68 |
62 |
$114.19 |
| 73000 |
|
166 |
116 |
$114.06 |
| A7033 |
Replacement nasal pillows |
445 |
443 |
$112.98 |
| 84703 |
|
3,112 |
3,071 |
$112.91 |
| 43235 |
|
124 |
122 |
$111.88 |
| 80178 |
|
1,251 |
1,168 |
$110.40 |
| 99383 |
|
93 |
93 |
$109.66 |
| 81002 |
|
2,883 |
2,620 |
$109.50 |
| 92508 |
|
23 |
12 |
$103.20 |
| 99395 |
|
2,799 |
2,777 |
$102.90 |
| 92588 |
|
26 |
26 |
$102.52 |
| 45380 |
|
604 |
603 |
$101.23 |
| A7031 |
Replacement facemask interfa |
1,157 |
1,152 |
$98.34 |
| 88141 |
|
1,428 |
1,428 |
$94.22 |
| 93227 |
|
55 |
52 |
$92.80 |
| 86708 |
|
1,588 |
1,576 |
$89.72 |
| 86304 |
|
826 |
742 |
$88.78 |
| 82985 |
|
734 |
723 |
$88.56 |
| 73521 |
|
19 |
13 |
$84.75 |
| 84153 |
|
6,599 |
6,515 |
$84.47 |
| 86769 |
|
220 |
219 |
$84.26 |
| 84466 |
|
242 |
233 |
$83.68 |
| 76882 |
|
223 |
187 |
$82.41 |
| 82390 |
|
589 |
585 |
$82.12 |
| 84478 |
|
343 |
305 |
$81.89 |
| 76857 |
|
86 |
83 |
$81.49 |
| 92568 |
|
235 |
233 |
$80.74 |
| 86765 |
|
1,526 |
1,522 |
$80.15 |
| 80175 |
|
122 |
116 |
$76.56 |
| 72220 |
|
97 |
78 |
$76.20 |
| 84165 |
|
2,983 |
2,857 |
$75.94 |
| 86709 |
|
593 |
589 |
$75.40 |
| 58301 |
|
431 |
421 |
$74.98 |
| A7015 |
Aerosol mask used w nebulize |
319 |
303 |
$74.63 |
| 96367 |
|
207 |
155 |
$71.42 |
| 76801 |
|
29 |
27 |
$71.36 |
| 96110 |
|
36 |
36 |
$69.00 |
| 86431 |
|
2,232 |
2,224 |
$67.80 |
| 95115 |
|
438 |
213 |
$65.07 |
| 85008 |
|
1,613 |
1,528 |
$64.83 |
| 90714 |
|
272 |
272 |
$63.50 |
| 87661 |
|
1,922 |
1,901 |
$58.61 |
| 86735 |
|
1,430 |
1,425 |
$57.95 |
| 82274 |
|
17,757 |
17,623 |
$56.71 |
| 99239 |
|
284 |
269 |
$53.40 |
| 86200 |
|
1,634 |
1,631 |
$52.19 |
| K0108 |
W/c component-accessory nos |
617 |
338 |
$50.00 |
| 82465 |
|
2,165 |
2,147 |
$49.41 |
| E0604 |
Hosp grade elec breast pump |
5,172 |
5,153 |
$48.40 |
| 84402 |
|
42 |
39 |
$47.87 |
| 72081 |
|
20 |
13 |
$46.18 |
| 82435 |
|
1,395 |
1,282 |
$45.93 |
| 84590 |
|
161 |
160 |
$42.00 |
| 87811 |
|
88 |
66 |
$41.38 |
| 93308 |
|
21 |
14 |
$40.53 |
| 83090 |
|
345 |
344 |
$40.48 |
| 87522 |
Neg quan hep c or qual rna |
381 |
372 |
$38.68 |
| 88300 |
|
146 |
129 |
$38.02 |
| 77072 |
|
37 |
28 |
$37.69 |
| 45385 |
|
176 |
175 |
$37.30 |
| 87497 |
|
74 |
52 |
$35.96 |
| 11750 |
|
43 |
43 |
$35.43 |
| A7013 |
Disposable compressor filter |
346 |
336 |
$34.48 |
| 87799 |
|
25 |
24 |
$34.27 |
| 12011 |
|
24 |
24 |
$33.56 |
| 86359 |
|
118 |
114 |
$33.53 |
| 86355 |
|
118 |
114 |
$33.53 |
| 86357 |
|
118 |
114 |
$33.37 |
| 85730 |
|
250 |
250 |
$32.83 |
| E0240 |
Bath/shower chair |
385 |
384 |
$31.77 |
| 99366 |
|
204 |
173 |
$30.54 |
| 84305 |
|
14 |
14 |
$30.24 |
| 83695 |
|
12 |
12 |
$30.03 |
| 83718 |
|
1,875 |
1,871 |
$29.36 |
| 95004 |
|
28 |
28 |
$27.17 |
| A7037 |
Pos airway pressure tubing |
4,929 |
4,900 |
$27.03 |
| 73501 |
|
37 |
28 |
$26.51 |
| 82950 |
|
4,604 |
4,280 |
$26.22 |
| 87806 |
|
164 |
164 |
$26.21 |
| A7035 |
Pos airway press headgear |
5,329 |
5,258 |
$25.99 |
| 73020 |
|
32 |
25 |
$21.61 |
| 82525 |
|
631 |
626 |
$21.00 |
| 85246 |
|
38 |
38 |
$20.39 |
| A4927 |
Non-sterile gloves |
4,858 |
4,592 |
$18.76 |
| A7038 |
Pos airway pressure filter |
5,639 |
5,574 |
$17.34 |
| E0156 |
Walker seat attachment |
231 |
231 |
$17.20 |
| 80156 |
|
27 |
26 |
$17.02 |
| 82374 |
|
945 |
835 |
$16.70 |
| 86592 |
|
460 |
452 |
$14.85 |
| 82164 |
|
13 |
13 |
$14.42 |
| 72082 |
|
15 |
14 |
$14.07 |
| 82397 |
|
18 |
17 |
$12.55 |
| 82103 |
|
139 |
137 |
$11.94 |
| 82951 |
|
298 |
281 |
$11.27 |
| 84425 |
|
1,094 |
1,089 |
$11.00 |
| 83010 |
|
15 |
12 |
$10.99 |
| 86593 |
|
782 |
769 |
$10.95 |
| 86255 |
|
14 |
14 |
$10.71 |
| 58300 |
|
865 |
842 |
$9.32 |
| 87338 |
|
476 |
474 |
$8.40 |
| 82952 |
|
276 |
275 |
$3.46 |
| 80053 |
|
261 |
229 |
$3.38 |
| J7613 |
Albuterol non-comp unit |
502 |
482 |
$3.08 |
| A6250 |
Skin seal protect moisturizr |
1,346 |
1,296 |
$2.82 |
| S0119 |
Ondansetron 4 mg |
12 |
12 |
$1.41 |
| 81000 |
|
12 |
12 |
$1.04 |
| A4335 |
Incontinence supply |
727 |
708 |
$0.46 |
| G9920 |
Scrning perf and negative |
2,204 |
2,132 |
$0.35 |
| V2020 |
Vision svcs frames purchases |
1,805 |
1,687 |
$0.00 |
| A0422 |
Ambulance 02 life sustaining |
334 |
301 |
$0.00 |
| J7307 |
Etonogestrel implant system |
395 |
392 |
$0.00 |
| 86696 |
|
161 |
160 |
$0.00 |
| A4385 |
Ost skn barrier sld ext wear |
463 |
444 |
$0.00 |
| Q0144 |
Azithromycin dihydrate, oral |
56 |
56 |
$0.00 |
| A7034 |
Nasal application device |
3,983 |
3,940 |
$0.00 |
| A4394 |
Ostomy pouch liq deodorant |
76 |
74 |
$0.00 |
| 86146 |
|
25 |
25 |
$0.00 |
| J1071 |
Inj testosterone cypionate |
477 |
258 |
$0.00 |
| A7046 |
Repl water chamber, pap dev |
2,774 |
2,769 |
$0.00 |
| J1756 |
Iron sucrose injection |
1,017 |
487 |
$0.00 |
| 88112 |
|
330 |
240 |
$0.00 |
| E0849 |
Cervical pneum trac equip |
242 |
242 |
$0.00 |
| V2750 |
Anti-reflective coating |
327 |
160 |
$0.00 |
| 81329 |
|
1,007 |
1,005 |
$0.00 |
| 90750 |
|
728 |
728 |
$0.00 |
| A4604 |
Tubing with heating element |
326 |
325 |
$0.00 |
| 11000 |
|
74 |
59 |
$0.00 |
| A4409 |
Ost skn barr convex <=4 sq i |
25 |
25 |
$0.00 |
| 90746 |
|
501 |
498 |
$0.00 |
| A7039 |
Filter, non disposable w pap |
152 |
152 |
$0.00 |
| 97813 |
|
228 |
195 |
$0.00 |
| 00840 |
|
14 |
14 |
$0.00 |
| 76706 |
|
12 |
12 |
$0.00 |
| A4267 |
Male condom |
67 |
67 |
$0.00 |
| 99396 |
|
1,941 |
1,924 |
$0.00 |
| 17110 |
|
954 |
927 |
$0.00 |
| 96900 |
|
828 |
192 |
$0.00 |
| S0199 |
Med abortion inc all ex drug |
25 |
24 |
$0.00 |
| 99397 |
|
379 |
378 |
$0.00 |
| S5199 |
Personal care item nos each |
904 |
852 |
$0.00 |
| 59409 |
|
224 |
220 |
$0.00 |
| 96417 |
|
21 |
13 |
$0.00 |
| 11100 |
|
374 |
373 |
$0.00 |
| 31575 |
|
242 |
229 |
$0.00 |
| 86147 |
|
43 |
42 |
$0.00 |
| A4362 |
Solid skin barrier |
42 |
38 |
$0.00 |
| A7005 |
Nondisposable nebulizer set |
38 |
36 |
$0.00 |
| 96523 |
|
13 |
12 |
$0.00 |
| 86015 |
|
149 |
145 |
$0.00 |
| A4332 |
Lube sterile packet |
12 |
12 |
$0.00 |
| T4532 |
Ped size pull-on lg |
40 |
40 |
$0.00 |
| E2601 |
Gen w/c cushion wdth < 22 in |
43 |
42 |
$0.00 |
| 20600 |
|
27 |
27 |
$0.00 |
| A4357 |
Bedside drainage bag |
66 |
65 |
$0.00 |
| 90836 |
|
89 |
72 |
$0.00 |
| A4425 |
Ost pch drain for barrier fl |
52 |
49 |
$0.00 |
| J1745 |
Infliximab not biosimil 10mg |
28 |
28 |
$0.00 |
| 93880 |
|
13 |
12 |
$0.00 |
| H0015 |
Alcohol and/or drug services |
152 |
38 |
$0.00 |
| 92081 |
|
26 |
26 |
$0.00 |
| 92570 |
|
26 |
26 |
$0.00 |
| 11981 |
|
78 |
77 |
$0.00 |
| 84207 |
|
90 |
88 |
$0.00 |
| 86644 |
|
12 |
12 |
$0.00 |
| 85705 |
|
30 |
30 |
$0.00 |
| S5000 |
Prescription drug, generic |
14 |
12 |
$0.00 |
| 01967 |
|
67 |
66 |
$0.00 |
| A4358 |
Urinary leg or abdomen bag |
15 |
14 |
$0.00 |
| 74178 |
|
16 |
16 |
$0.00 |
| 92552 |
|
28 |
28 |
$0.00 |
| T2007 |
Non-emer transport wait time |
52 |
37 |
$0.00 |
| 95810 |
|
12 |
12 |
$0.00 |
| 11104 |
|
31 |
31 |
$0.00 |
| A5513 |
Multi den insert custom mold |
14 |
14 |
$0.00 |
| 96116 |
|
13 |
12 |
$0.00 |
| 82239 |
|
14 |
13 |
$0.00 |
| C9803 |
Hopd covid-19 spec collect |
25 |
14 |
$0.00 |
| 86645 |
|
13 |
13 |
$0.00 |
| 86334 |
|
12 |
12 |
$0.00 |
| 92556 |
|
13 |
13 |
$0.00 |
| 11055 |
|
52 |
52 |
$0.00 |
| A9900 |
Supply/accessory/service |
242 |
239 |
$0.00 |
| 1036F |
|
5,349 |
5,104 |
$0.00 |
| 97814 |
|
208 |
175 |
$0.00 |
| V2781 |
Progressive lens per lens |
28 |
14 |
$0.00 |
| 85240 |
|
51 |
51 |
$0.00 |
| A4351 |
Straight tip urine catheter |
467 |
432 |
$0.00 |
| 87517 |
|
1,074 |
1,001 |
$0.00 |
| A4371 |
Skin barrier powder per oz |
37 |
37 |
$0.00 |
| E1399 |
Durable medical equipment mi |
401 |
390 |
$0.00 |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
864 |
455 |
$0.00 |
| T4537 |
Reusable underpad bed size |
144 |
137 |
$0.00 |
| E0720 |
Tens two lead |
12 |
12 |
$0.00 |
| 58100 |
|
502 |
496 |
$0.00 |
| 57454 |
|
398 |
397 |
$0.00 |
| J7298 |
Mirena, 52 mg |
609 |
609 |
$0.00 |
| 92136 |
|
25 |
25 |
$0.00 |
| 93016 |
|
50 |
50 |
$0.00 |
| 93018 |
|
38 |
37 |
$0.00 |
| 82378 |
|
241 |
226 |
$0.00 |
| 90632 |
|
109 |
109 |
$0.00 |
| 59840 |
|
165 |
125 |
$0.00 |
| A7032 |
Replacement nasal cushion |
1,820 |
1,804 |
$0.00 |
| 11102 |
|
178 |
177 |
$0.00 |
| 86695 |
|
143 |
142 |
$0.00 |
| 73700 |
|
57 |
52 |
$0.00 |
| 99000 |
|
62 |
61 |
$0.00 |
| G9012 |
Other specified case mgmt |
1,879 |
1,244 |
$0.00 |
| 11900 |
|
85 |
81 |
$0.00 |
| 93280 |
|
49 |
39 |
$0.00 |
| J3420 |
Vitamin b12 injection |
1,099 |
1,022 |
$0.00 |
| A4520 |
Incontinence garment anytype |
1,379 |
1,225 |
$0.00 |
| 52000 |
|
213 |
208 |
$0.00 |
| 11730 |
|
51 |
50 |
$0.00 |
| A0426 |
Als 1 |
12 |
12 |
$0.00 |
| 94760 |
|
96 |
95 |
$0.00 |
| J7300 |
Intra copp contra (paragard) |
44 |
44 |
$0.00 |
| 99386 |
|
749 |
742 |
$0.00 |
| 0250 |
|
47 |
42 |
$0.00 |
| 17000 |
|
47 |
46 |
$0.00 |
| 86320 |
|
51 |
50 |
$0.00 |
| B9998 |
Enteral supp not otherwise c |
13 |
13 |
$0.00 |
| 11976 |
|
238 |
228 |
$0.00 |
| 0301 |
|
26 |
26 |
$0.00 |
| 0305 |
|
41 |
40 |
$0.00 |
| 95819 |
|
15 |
14 |
$0.00 |
| A4456 |
Adhesive remover, wipes |
54 |
52 |
$0.00 |
| 88184 |
|
27 |
27 |
$0.00 |
| 59514 |
|
40 |
40 |
$0.00 |
| 90636 |
|
56 |
55 |
$0.00 |
| 97035 |
|
35 |
26 |
$0.00 |
| 51798 |
|
27 |
26 |
$0.00 |
| 70543 |
|
12 |
12 |
$0.00 |
| 41899 |
|
14 |
14 |
$0.00 |
| 96409 |
|
18 |
12 |
$0.00 |
| 70460 |
|
26 |
25 |
$0.00 |
| 99462 |
|
17 |
12 |
$0.00 |
| A0420 |
Ambulance waiting 1/2 hr |
169 |
80 |
$0.00 |
| J7611 |
Albuterol non-comp con |
86 |
82 |
$0.00 |
| 86381 |
|
34 |
33 |
$0.00 |
| 92551 |
|
25 |
25 |
$0.00 |
| 88185 |
|
27 |
27 |
$0.00 |
| 99460 |
|
48 |
46 |
$0.00 |
| 72146 |
|
13 |
12 |
$0.00 |
| 85397 |
|
12 |
12 |
$0.00 |
| A0999 |
Unlisted ambulance service |
16 |
13 |
$0.00 |
| 98967 |
|
13 |
12 |
$0.00 |
| 91200 |
|
13 |
12 |
$0.00 |
| A4349 |
Disposable male external cat |
12 |
12 |
$0.00 |
| A9585 |
Gadobutrol injection |
13 |
13 |
$0.00 |
| 87350 |
|
12 |
12 |
$0.00 |
| 20550 |
|
25 |
25 |
$0.00 |
| J1950 |
Leuprolide acetate /3.75 mg |
13 |
12 |
$0.00 |