| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 80053 |
|
10,043 |
7,841 |
$305K |
| 70450 |
|
2,058 |
1,814 |
$249K |
| 99283 |
|
2,996 |
2,235 |
$155K |
| 74177 |
|
792 |
663 |
$121K |
| 96365 |
|
1,088 |
953 |
$117K |
| 87426 |
|
3,099 |
2,823 |
$92K |
| 97110 |
|
5,161 |
902 |
$91K |
| 85025 |
|
9,303 |
7,576 |
$82K |
| 96361 |
|
1,701 |
1,232 |
$80K |
| 96372 |
|
4,614 |
3,848 |
$65K |
| 83880 |
|
2,066 |
1,645 |
$63K |
| 99284 |
|
1,472 |
1,153 |
$61K |
| 96374 |
|
2,230 |
1,808 |
$56K |
| 93005 |
|
3,162 |
2,661 |
$44K |
| 84484 |
|
3,392 |
2,734 |
$40K |
| 83874 |
|
2,204 |
1,798 |
$39K |
| 74176 |
|
411 |
361 |
$36K |
| 99285 |
|
1,439 |
1,183 |
$36K |
| 80307 |
|
554 |
480 |
$35K |
| 71045 |
|
3,705 |
3,202 |
$35K |
| 87081 |
|
3,401 |
3,132 |
$32K |
| 96375 |
|
1,765 |
1,450 |
$30K |
| 87430 |
|
2,060 |
1,866 |
$25K |
| 87899 |
|
2,142 |
1,950 |
$25K |
| 94760 |
|
1,162 |
1,058 |
$24K |
| 87880 |
|
1,971 |
1,823 |
$23K |
| 71046 |
|
1,451 |
1,207 |
$23K |
| 80305 |
|
1,548 |
1,377 |
$22K |
| 94761 |
|
1,109 |
971 |
$19K |
| 85027 |
|
2,297 |
1,568 |
$18K |
| 83690 |
|
1,900 |
1,647 |
$18K |
| 87400 |
|
2,558 |
2,342 |
$16K |
| 81025 |
|
1,750 |
1,598 |
$15K |
| 81003 |
|
4,407 |
3,881 |
$13K |
| 82150 |
|
815 |
722 |
$10K |
| 85378 |
|
1,317 |
1,158 |
$10K |
| 85730 |
|
1,599 |
1,374 |
$9K |
| 74019 |
|
492 |
453 |
$9K |
| 83605 |
|
661 |
572 |
$8K |
| 36415 |
|
3,949 |
2,794 |
$7K |
| 80048 |
|
438 |
373 |
$7K |
| 85610 |
|
1,937 |
1,575 |
$7K |
| 86756 |
|
394 |
376 |
$7K |
| 82550 |
|
677 |
567 |
$6K |
| 83735 |
|
768 |
613 |
$6K |
| 81001 |
|
1,346 |
1,197 |
$5K |
| 87807 |
|
439 |
405 |
$5K |
| 99281 |
|
108 |
80 |
$5K |
| 87040 |
|
473 |
425 |
$5K |
| 73562 |
|
128 |
102 |
$5K |
| 84443 |
|
391 |
334 |
$4K |
| 87086 |
|
386 |
342 |
$3K |
| 72125 |
|
16 |
13 |
$3K |
| 99282 |
|
48 |
41 |
$3K |
| J0696 |
Ceftriaxone sodium injection |
323 |
253 |
$2K |
| 97161 |
|
41 |
27 |
$2K |
| J1885 |
Ketorolac tromethamine inj |
480 |
392 |
$2K |
| 94640 |
|
221 |
147 |
$1K |
| 71010 |
|
221 |
208 |
$1K |
| 97001 |
|
16 |
15 |
$1K |
| 80320 |
|
69 |
62 |
$999.92 |
| 72100 |
|
43 |
39 |
$980.67 |
| 73630 |
|
42 |
37 |
$911.33 |
| J2405 |
Ondansetron hcl injection |
303 |
242 |
$866.81 |
| J1100 |
Dexamethasone sodium phos |
69 |
65 |
$762.02 |
| 73130 |
|
20 |
12 |
$664.25 |
| 80050 |
|
13 |
12 |
$632.71 |
| 71020 |
|
38 |
34 |
$563.30 |
| 73610 |
|
30 |
26 |
$555.30 |
| 74018 |
|
45 |
40 |
$519.78 |
| 96360 |
|
14 |
12 |
$459.30 |
| 76856 |
|
12 |
12 |
$446.20 |
| 86140 |
|
47 |
39 |
$286.83 |
| 87635 |
|
84 |
83 |
$234.80 |
| 80061 |
|
13 |
13 |
$213.20 |
| 73030 |
|
18 |
13 |
$198.65 |
| J2930 |
Methylprednisolone injection |
39 |
29 |
$114.94 |
| J7510 |
Prednisolone oral per 5 mg |
30 |
29 |
$64.61 |
| J2270 |
Morphine sulfate injection |
85 |
62 |
$25.82 |
| J2919 |
Inj, methylpred sod succ 5mg |
73 |
55 |
$11.69 |
| G0378 |
Hospital observation per hr |
13 |
12 |
$0.00 |
| J7030 |
Normal saline solution infus |
14 |
12 |
$0.00 |