| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 0450 |
|
2,942 |
2,681 |
$604K |
| 80053 |
|
2,779 |
2,603 |
$275K |
| T1999 |
Noc retail items andsupplies |
1,054 |
526 |
$156K |
| Z7502 |
|
2,690 |
2,678 |
$100K |
| 71046 |
|
781 |
763 |
$73K |
| 80048 |
|
440 |
423 |
$50K |
| 99283 |
|
2,821 |
2,654 |
$41K |
| 81025 |
|
1,094 |
1,036 |
$38K |
| Z7610 |
|
1,625 |
878 |
$22K |
| J7030 |
Normal saline solution infus |
1,297 |
1,187 |
$18K |
| 99281 |
|
474 |
430 |
$17K |
| 70450 |
|
404 |
398 |
$16K |
| 71020 |
|
65 |
60 |
$14K |
| 85025 |
|
3,638 |
3,344 |
$12K |
| 36415 |
|
1,277 |
1,161 |
$12K |
| 0516 |
|
205 |
197 |
$11K |
| 73610 |
|
85 |
83 |
$10K |
| 99282 |
|
976 |
928 |
$9K |
| 0250 |
|
850 |
753 |
$9K |
| 96372 |
|
572 |
557 |
$8K |
| 80306 |
|
313 |
306 |
$8K |
| J3490 |
Drugs unclassified injection |
3,060 |
1,540 |
$8K |
| 81001 |
|
1,735 |
1,653 |
$7K |
| 99284 |
|
1,642 |
1,520 |
$7K |
| 96374 |
|
1,060 |
994 |
$6K |
| 74177 |
|
285 |
283 |
$5K |
| 93005 |
|
1,684 |
1,282 |
$5K |
| 73630 |
|
92 |
89 |
$5K |
| 96375 |
|
728 |
686 |
$4K |
| 87400 |
|
236 |
233 |
$4K |
| 96361 |
|
893 |
849 |
$4K |
| 74018 |
|
27 |
27 |
$4K |
| 96360 |
|
207 |
206 |
$3K |
| 96365 |
|
117 |
100 |
$3K |
| 84702 |
|
319 |
293 |
$3K |
| 74176 |
|
159 |
155 |
$3K |
| 71045 |
|
409 |
389 |
$3K |
| G0480 |
Drug test def 1-7 classes |
251 |
237 |
$2K |
| 82962 |
|
355 |
312 |
$2K |
| 87880 |
|
278 |
272 |
$2K |
| 84484 |
|
603 |
539 |
$2K |
| 82553 |
|
302 |
277 |
$1K |
| 87086 |
|
486 |
470 |
$1K |
| 73110 |
|
12 |
12 |
$1K |
| 87502 |
|
283 |
280 |
$993.50 |
| 83690 |
|
1,162 |
1,083 |
$771.65 |
| J1885 |
Ketorolac tromethamine inj |
652 |
621 |
$760.36 |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
347 |
344 |
$750.99 |
| 87077 |
|
192 |
187 |
$728.76 |
| 76705 |
|
41 |
40 |
$619.54 |
| 87280 |
|
81 |
80 |
$617.68 |
| 81003 |
|
990 |
954 |
$585.32 |
| 99285 |
|
455 |
428 |
$542.20 |
| 82550 |
|
346 |
319 |
$506.09 |
| 94640 |
|
238 |
209 |
$405.52 |
| 0271 |
|
306 |
300 |
$369.25 |
| G0463 |
Hospital outpt clinic visit |
576 |
540 |
$294.41 |
| J0696 |
Ceftriaxone sodium injection |
317 |
304 |
$283.01 |
| 59025 |
|
16 |
13 |
$225.63 |
| 87040 |
|
196 |
189 |
$221.11 |
| 36416 |
|
63 |
60 |
$219.97 |
| 85610 |
|
577 |
544 |
$219.36 |
| 85730 |
|
422 |
405 |
$214.86 |
| J2405 |
Ondansetron hcl injection |
647 |
607 |
$211.36 |
| J2270 |
Morphine sulfate injection |
337 |
310 |
$192.72 |
| 0272 |
|
207 |
191 |
$171.98 |
| 87491 |
|
25 |
25 |
$163.58 |
| 87591 |
|
25 |
25 |
$163.50 |
| 83735 |
|
301 |
285 |
$162.60 |
| 87186 |
|
172 |
168 |
$158.77 |
| 84443 |
|
26 |
25 |
$139.32 |
| 83880 |
|
98 |
92 |
$114.99 |
| 83605 |
|
185 |
178 |
$98.33 |
| J2765 |
Metoclopramide hcl injection |
136 |
132 |
$86.79 |
| 81002 |
|
26 |
26 |
$54.44 |
| J1200 |
Diphenhydramine hcl injectio |
42 |
41 |
$35.39 |
| 87651 |
|
12 |
12 |
$27.73 |
| J2060 |
Lorazepam injection |
55 |
52 |
$23.55 |
| 86140 |
|
13 |
13 |
$18.39 |
| 86901 |
|
43 |
39 |
$18.19 |
| 86900 |
|
43 |
39 |
$14.23 |
| J1100 |
Dexamethasone sodium phos |
62 |
61 |
$11.13 |
| 90471 |
|
26 |
26 |
$4.46 |
| 0270 |
|
166 |
98 |
$0.82 |
| A9270 |
Non-covered item or service |
2,404 |
2,171 |
$0.63 |
| G0378 |
Hospital observation per hr |
12 |
12 |
$0.00 |
| Q0162 |
Ondansetron oral |
369 |
358 |
$0.00 |
| 0258 |
|
14 |
13 |
$0.00 |
| J2001 |
Lidocaine injection |
16 |
16 |
$0.00 |
| 90715 |
|
14 |
14 |
$0.00 |