| Code | Description | Claims | Beneficiaries | Total Paid |
| 97110 |
|
80,567 |
11,774 |
$6.22M |
| 97162 |
|
4,251 |
2,678 |
$215K |
| 90651 |
|
2,101 |
734 |
$173K |
| 87389 |
|
4,763 |
3,659 |
$125K |
| 90670 |
|
2,523 |
881 |
$116K |
| 92507 |
|
7,621 |
2,641 |
$106K |
| 90715 |
|
4,024 |
1,538 |
$104K |
| 97161 |
|
2,178 |
1,341 |
$97K |
| U0003 |
Cov-19 amp prb hgh thruput |
1,347 |
466 |
$96K |
| 77067 |
|
1,450 |
1,350 |
$84K |
| 87651 |
|
4,169 |
3,558 |
$81K |
| 87633 |
|
537 |
404 |
$78K |
| 84443 |
|
13,404 |
10,666 |
$77K |
| J1050 |
Medroxyprogesterone acetate |
2,147 |
1,047 |
$76K |
| 80053 |
|
27,912 |
18,655 |
$75K |
| 87591 |
|
6,076 |
4,667 |
$61K |
| 87502 |
|
1,799 |
1,478 |
$60K |
| 87491 |
|
6,089 |
4,672 |
$58K |
| 96372 |
|
7,600 |
3,510 |
$58K |
| Q2038 |
Fluzone vacc, 3 yrs & >, im |
3,289 |
1,952 |
$45K |
| 92557 |
|
1,049 |
933 |
$38K |
| 96413 |
|
2,963 |
889 |
$37K |
| 93005 |
|
3,803 |
3,043 |
$36K |
| 17110 |
|
593 |
480 |
$35K |
| 90746 |
|
584 |
260 |
$35K |
| 90734 |
|
1,024 |
384 |
$34K |
| 87507 |
|
195 |
164 |
$31K |
| 97163 |
|
439 |
296 |
$28K |
| 85025 |
|
26,935 |
16,661 |
$27K |
| 87880 |
|
4,031 |
3,433 |
$26K |
| 88305 |
|
1,039 |
587 |
$25K |
| 86480 |
|
1,154 |
894 |
$25K |
| 71046 |
|
2,971 |
2,345 |
$24K |
| 87624 |
|
2,336 |
1,833 |
$24K |
| 0002A |
|
577 |
549 |
$22K |
| 95004 |
|
616 |
335 |
$21K |
| 87635 |
|
1,282 |
500 |
$21K |
| 90750 |
|
144 |
45 |
$20K |
| 87631 |
|
416 |
361 |
$20K |
| 0001A |
|
626 |
594 |
$19K |
| 73610 |
|
1,102 |
922 |
$19K |
| 92567 |
|
1,218 |
1,072 |
$18K |
| 73630 |
|
1,356 |
1,135 |
$18K |
| 90732 |
|
258 |
107 |
$17K |
| 83655 |
|
3,098 |
2,458 |
$17K |
| 83970 |
|
1,266 |
1,018 |
$17K |
| 95117 |
|
2,000 |
703 |
$15K |
| 94640 |
|
1,097 |
587 |
$15K |
| 80048 |
|
5,906 |
4,124 |
$14K |
| 90662 |
|
259 |
97 |
$13K |
| 87536 |
|
341 |
233 |
$13K |
| 99211 |
|
1,326 |
690 |
$13K |
| 82306 |
|
7,590 |
6,013 |
$13K |
| 80307 |
|
627 |
473 |
$12K |
| 73562 |
|
971 |
821 |
$12K |
| 90710 |
|
483 |
136 |
$11K |
| 99212 |
|
601 |
339 |
$11K |
| 73030 |
|
850 |
726 |
$11K |
| J0702 |
Betamethasone acet&sod phosp |
1,674 |
316 |
$11K |
| 73564 |
|
679 |
564 |
$10K |
| 77066 |
Tomosynthesis, mammo |
142 |
128 |
$10K |
| 94375 |
|
279 |
194 |
$10K |
| 87653 |
|
736 |
601 |
$9K |
| 80061 |
|
11,859 |
9,443 |
$9K |
| 51701 |
|
415 |
335 |
$9K |
| 92134 |
|
1,047 |
907 |
$9K |
| 95165 |
|
1,454 |
529 |
$9K |
| 80197 |
|
2,467 |
1,014 |
$9K |
| 92083 |
|
399 |
331 |
$9K |
| 86235 |
|
296 |
229 |
$9K |
| 73130 |
|
791 |
628 |
$9K |
| 87799 |
|
383 |
250 |
$9K |
| 87086 |
|
3,615 |
2,852 |
$8K |
| 85610 |
|
7,254 |
3,889 |
$8K |
| 82784 |
|
1,493 |
1,094 |
$8K |
| 90698 |
|
1,637 |
546 |
$8K |
| 86780 |
|
2,729 |
1,982 |
$8K |
| J3420 |
Vitamin b12 injection |
2,325 |
866 |
$8K |
| 84403 |
|
745 |
617 |
$7K |
| 92523 |
|
457 |
422 |
$7K |
| 96365 |
|
757 |
93 |
$7K |
| 87798 |
|
673 |
485 |
$7K |
| 96375 |
|
841 |
173 |
$7K |
| 90707 |
|
360 |
120 |
$7K |
| 81003 |
|
10,417 |
7,358 |
$7K |
| 73110 |
|
559 |
434 |
$7K |
| 69210 |
|
294 |
225 |
$7K |
| 85027 |
|
6,944 |
5,519 |
$7K |
| 96409 |
|
151 |
50 |
$7K |
| 83036 |
|
7,085 |
5,667 |
$6K |
| 83735 |
|
5,134 |
2,453 |
$6K |
| 84439 |
|
5,531 |
4,520 |
$6K |
| 90685 |
|
1,036 |
400 |
$6K |
| 86803 |
|
1,719 |
1,329 |
$6K |
| 72110 |
|
326 |
297 |
$6K |
| G0103 |
Psa screening |
870 |
693 |
$6K |
| 82105 |
|
931 |
759 |
$6K |
| 96366 |
|
321 |
40 |
$6K |
| 96367 |
|
474 |
76 |
$5K |
| 90633 |
|
758 |
226 |
$5K |
| 90716 |
|
152 |
43 |
$5K |
| 90680 |
|
1,200 |
369 |
$5K |
| 72100 |
|
380 |
322 |
$5K |
| 97166 |
|
444 |
339 |
$5K |
| 73140 |
|
619 |
497 |
$5K |
| 82570 |
|
4,536 |
3,017 |
$5K |
| 90744 |
|
917 |
291 |
$5K |
| 86038 |
|
1,164 |
902 |
$5K |
| 73560 |
|
523 |
446 |
$5K |
| 81001 |
|
7,568 |
5,636 |
$4K |
| 87186 |
|
1,273 |
1,025 |
$4K |
| 72190 |
|
166 |
144 |
$4K |
| 0003A |
|
103 |
84 |
$4K |
| 82607 |
|
945 |
716 |
$4K |
| 84466 |
|
2,381 |
1,887 |
$4K |
| 87522 |
Neg quan hep c or qual rna |
164 |
118 |
$4K |
| 87340 |
|
1,763 |
1,373 |
$4K |
| G0123 |
Screen cerv/vag thin layer |
3,178 |
2,438 |
$4K |
| 83883 |
|
569 |
371 |
$4K |
| 86706 |
|
1,171 |
876 |
$4K |
| 80074 |
|
481 |
347 |
$4K |
| Q2036 |
Flulaval vacc, 3 yrs & >, im |
261 |
216 |
$3K |
| 80076 |
|
1,397 |
1,067 |
$3K |
| 86003 |
|
379 |
293 |
$3K |
| 86832 |
|
65 |
36 |
$3K |
| 72082 |
|
139 |
121 |
$3K |
| 84100 |
|
3,465 |
1,473 |
$3K |
| 86334 |
|
292 |
177 |
$3K |
| 20550 |
|
122 |
68 |
$3K |
| 74018 |
|
353 |
323 |
$3K |
| 82728 |
|
3,350 |
2,676 |
$3K |
| 86787 |
|
872 |
630 |
$3K |
| 86160 |
|
488 |
349 |
$3K |
| 0071A |
|
71 |
71 |
$3K |
| J3301 |
Triamcinolone acet inj nos |
718 |
305 |
$3K |
| 87581 |
|
537 |
404 |
$3K |
| 73100 |
|
219 |
169 |
$3K |
| 81025 |
|
4,949 |
3,611 |
$3K |
| 92133 |
|
406 |
347 |
$3K |
| 90696 |
|
449 |
125 |
$3K |
| 87486 |
|
537 |
404 |
$3K |
| 84481 |
|
2,267 |
1,848 |
$3K |
| 73620 |
|
386 |
322 |
$3K |
| 0012A |
|
99 |
99 |
$3K |
| 83615 |
|
3,565 |
1,586 |
$3K |
| 83001 |
|
503 |
411 |
$3K |
| 0072A |
|
56 |
53 |
$2K |
| 73502 |
|
138 |
113 |
$2K |
| 73600 |
|
239 |
192 |
$2K |
| 86140 |
|
2,757 |
2,035 |
$2K |
| 72050 |
|
162 |
137 |
$2K |
| 96415 |
|
160 |
49 |
$2K |
| 86704 |
|
514 |
357 |
$2K |
| 72120 |
|
88 |
70 |
$2K |
| 87081 |
|
2,743 |
2,350 |
$2K |
| 0004A |
|
52 |
31 |
$2K |
| J1100 |
Dexamethasone sodium phos |
956 |
218 |
$2K |
| 83540 |
|
2,824 |
2,248 |
$2K |
| 92060 |
|
248 |
208 |
$2K |
| 73590 |
|
201 |
168 |
$2K |
| 72040 |
|
192 |
189 |
$2K |
| 83880 |
|
365 |
253 |
$2K |
| 86850 |
|
1,527 |
997 |
$2K |
| 82962 |
|
3,250 |
2,143 |
$2K |
| 82746 |
|
450 |
355 |
$2K |
| 84702 |
|
657 |
436 |
$2K |
| 87088 |
|
590 |
505 |
$2K |
| 87661 |
|
559 |
433 |
$2K |
| 87070 |
|
1,238 |
958 |
$2K |
| 84153 |
|
327 |
282 |
$2K |
| 86901 |
|
1,750 |
1,119 |
$2K |
| 97165 |
|
200 |
122 |
$2K |
| 87808 |
|
680 |
544 |
$2K |
| 85018 |
|
3,326 |
2,590 |
$2K |
| 83037 |
|
2,151 |
1,241 |
$2K |
| 29075 |
|
34 |
30 |
$2K |
| 72170 |
|
200 |
178 |
$1K |
| 80069 |
|
640 |
531 |
$1K |
| 0011A |
|
87 |
87 |
$1K |
| 96374 |
|
89 |
14 |
$1K |
| 84156 |
|
2,661 |
1,664 |
$1K |
| 82043 |
|
2,647 |
2,058 |
$1K |
| 96417 |
|
141 |
26 |
$1K |
| 86900 |
|
1,769 |
1,117 |
$1K |
| 84146 |
|
482 |
403 |
$1K |
| 85730 |
|
836 |
594 |
$1K |
| 83718 |
|
334 |
245 |
$1K |
| 83516 |
|
690 |
558 |
$1K |
| 11721 |
|
60 |
48 |
$1K |
| 86580 |
|
438 |
331 |
$1K |
| 90632 |
|
21 |
13 |
$1K |
| 96910 |
|
262 |
38 |
$1K |
| 73090 |
|
119 |
89 |
$995.62 |
| 86431 |
|
679 |
486 |
$981.29 |
| 86708 |
|
389 |
270 |
$975.42 |
| 84165 |
|
421 |
269 |
$968.03 |
| 96402 |
|
107 |
88 |
$967.15 |
| 85014 |
|
2,434 |
1,883 |
$955.27 |
| 87496 |
|
66 |
42 |
$954.99 |
| 83020 |
|
668 |
512 |
$942.61 |
| 87905 |
|
735 |
589 |
$923.59 |
| 86200 |
|
316 |
233 |
$921.36 |
| 82950 |
|
983 |
769 |
$893.26 |
| 77065 |
Tomosynthesis, mammo |
13 |
13 |
$859.82 |
| G0283 |
Elec stim other than wound |
58 |
15 |
$859.48 |
| 83721 |
|
481 |
350 |
$824.98 |
| 99173 |
|
134 |
107 |
$819.85 |
| 85652 |
|
1,625 |
1,197 |
$805.01 |
| 73080 |
|
92 |
85 |
$799.31 |
| 86800 |
|
324 |
271 |
$773.84 |
| 85651 |
|
1,197 |
883 |
$717.96 |
| 93296 |
|
36 |
29 |
$676.08 |
| 86833 |
|
14 |
12 |
$655.69 |
| 84425 |
|
155 |
127 |
$649.91 |
| 84460 |
|
928 |
768 |
$643.97 |
| 82565 |
|
546 |
308 |
$613.17 |
| 82550 |
|
674 |
519 |
$609.08 |
| 84550 |
|
981 |
660 |
$587.63 |
| 99213 |
|
21 |
15 |
$579.18 |
| J3475 |
Inj magnesium sulfate |
109 |
12 |
$576.73 |
| 94760 |
|
231 |
173 |
$546.58 |
| 86376 |
|
377 |
284 |
$544.04 |
| 86762 |
|
555 |
424 |
$518.88 |
| 86225 |
|
207 |
159 |
$518.22 |
| 0124A |
|
12 |
12 |
$458.68 |
| J1885 |
Ketorolac tromethamine inj |
87 |
38 |
$457.86 |
| 73070 |
|
39 |
38 |
$441.34 |
| 83690 |
|
463 |
338 |
$435.06 |
| 92579 |
|
20 |
12 |
$431.03 |
| 87147 |
|
211 |
192 |
$429.31 |
| 11102 |
|
20 |
12 |
$428.76 |
| 87205 |
|
752 |
550 |
$415.84 |
| 84703 |
|
217 |
188 |
$406.82 |
| 87634 |
|
24 |
22 |
$404.80 |
| J9370 |
Vincristine sulfate 1 mg inj |
67 |
36 |
$377.83 |
| 84450 |
|
657 |
565 |
$377.10 |
| 85045 |
|
1,103 |
774 |
$369.50 |
| 83002 |
|
208 |
176 |
$347.35 |
| 86592 |
|
587 |
480 |
$339.86 |
| 86769 |
|
27 |
18 |
$312.60 |
| 86765 |
|
229 |
167 |
$306.54 |
| 82947 |
|
958 |
792 |
$297.86 |
| 70355 |
|
22 |
22 |
$295.59 |
| 86255 |
|
107 |
88 |
$274.29 |
| 87497 |
|
15 |
13 |
$244.10 |
| 81002 |
|
329 |
260 |
$230.62 |
| 82525 |
|
82 |
69 |
$216.01 |
| 82465 |
|
473 |
356 |
$210.01 |
| 84630 |
|
90 |
72 |
$196.28 |
| 84402 |
|
83 |
81 |
$187.82 |
| 82248 |
|
139 |
100 |
$165.66 |
| 73552 |
|
17 |
14 |
$158.09 |
| 82785 |
|
105 |
88 |
$153.96 |
| 84445 |
|
16 |
15 |
$144.32 |
| 84484 |
|
106 |
69 |
$139.08 |
| 86361 |
|
64 |
37 |
$134.11 |
| 82951 |
|
24 |
24 |
$129.75 |
| 85613 |
|
67 |
25 |
$127.35 |
| 83013 |
|
25 |
25 |
$114.59 |
| 82103 |
|
40 |
24 |
$96.38 |
| 80177 |
|
26 |
24 |
$88.92 |
| 82310 |
|
66 |
52 |
$73.96 |
| 84590 |
|
104 |
76 |
$72.88 |
| 81050 |
|
111 |
89 |
$71.68 |
| 84432 |
|
19 |
13 |
$69.90 |
| 84446 |
|
34 |
31 |
$51.72 |
| J0696 |
Ceftriaxone sodium injection |
61 |
31 |
$50.19 |
| J2469 |
Palonosetron hcl |
68 |
12 |
$46.47 |
| 83014 |
|
25 |
25 |
$45.96 |
| 84270 |
|
12 |
12 |
$40.95 |
| 87101 |
|
23 |
12 |
$39.26 |
| 77063 |
|
16 |
14 |
$31.21 |
| 83010 |
|
15 |
15 |
$30.77 |
| 36415 |
|
486 |
436 |
$28.37 |
| 86735 |
|
13 |
12 |
$24.89 |
| 90471 |
|
2,672 |
2,448 |
$23.68 |
| 84520 |
|
83 |
45 |
$22.15 |
| 84305 |
|
14 |
14 |
$22.02 |
| 82040 |
|
30 |
14 |
$19.71 |
| 86705 |
|
16 |
13 |
$14.98 |
| 82150 |
|
20 |
13 |
$9.30 |
| 82247 |
|
14 |
12 |
$9.08 |
| 87077 |
|
54 |
45 |
$8.85 |
| 82952 |
|
12 |
12 |
$5.73 |
| 90474 |
|
116 |
115 |
$0.00 |
| 90472 |
|
745 |
615 |
$0.00 |
| C9803 |
Hopd covid-19 spec collect |
257 |
73 |
$0.00 |
| Q0091 |
Obtaining screen pap smear |
42 |
38 |
$0.00 |
| 97803 |
|
31 |
30 |
$0.00 |
| - |
Outside state ambulance serv |
61 |
44 |
$0.00 |