| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99283 |
|
4,106 |
3,081 |
$313K |
| 99284 |
|
1,985 |
1,442 |
$132K |
| 99282 |
|
1,012 |
743 |
$71K |
| 74177 |
|
376 |
283 |
$41K |
| 99281 |
|
479 |
343 |
$40K |
| 96374 |
|
1,214 |
881 |
$35K |
| 80053 |
|
1,524 |
1,150 |
$18K |
| 96372 |
|
626 |
497 |
$17K |
| 96361 |
|
559 |
408 |
$16K |
| 87070 |
|
525 |
389 |
$16K |
| 83690 |
|
880 |
648 |
$8K |
| 81001 |
|
1,288 |
962 |
$7K |
| 71046 |
|
383 |
294 |
$7K |
| 87430 |
|
596 |
449 |
$5K |
| 80048 |
|
285 |
229 |
$5K |
| 96375 |
|
568 |
402 |
$4K |
| 71045 |
|
621 |
496 |
$3K |
| 85027 |
|
1,869 |
1,392 |
$3K |
| 81025 |
|
687 |
518 |
$3K |
| 70450 |
|
52 |
42 |
$3K |
| 87804 |
|
365 |
292 |
$2K |
| 84484 |
|
487 |
383 |
$2K |
| 93005 |
|
784 |
600 |
$2K |
| 93975 |
|
15 |
15 |
$2K |
| 87491 |
|
125 |
95 |
$2K |
| 87420 |
|
65 |
48 |
$2K |
| 87088 |
|
48 |
38 |
$1K |
| 99285 |
|
12 |
12 |
$1K |
| 84703 |
|
493 |
379 |
$1K |
| 87591 |
|
125 |
95 |
$981.54 |
| 87661 |
|
117 |
92 |
$957.20 |
| J7030 |
Normal saline solution infus |
1,071 |
766 |
$943.15 |
| 96360 |
|
38 |
24 |
$788.50 |
| 83880 |
|
31 |
24 |
$529.76 |
| J1885 |
Ketorolac tromethamine inj |
1,359 |
690 |
$429.76 |
| 94640 |
|
17 |
14 |
$406.20 |
| 87210 |
|
17 |
12 |
$292.46 |
| 73630 |
|
14 |
13 |
$149.76 |
| 85730 |
|
91 |
76 |
$143.50 |
| 87426 |
|
14 |
14 |
$141.36 |
| 85610 |
|
144 |
117 |
$126.43 |
| J0696 |
Ceftriaxone sodium injection |
160 |
132 |
$96.28 |
| J2405 |
Ondansetron hcl injection |
619 |
440 |
$75.44 |
| J1100 |
Dexamethasone sodium phos |
231 |
167 |
$74.77 |
| J8540 |
Oral dexamethasone |
41 |
30 |
$72.96 |
| J1200 |
Diphenhydramine hcl injectio |
234 |
164 |
$59.70 |
| 73130 |
|
12 |
12 |
$52.20 |
| J2765 |
Metoclopramide hcl injection |
96 |
68 |
$33.37 |
| 81003 |
|
51 |
41 |
$29.07 |
| J2270 |
Morphine sulfate injection |
19 |
12 |
$18.40 |
| J7050 |
Normal saline solution infus |
310 |
223 |
$11.79 |
| Q0162 |
Ondansetron oral |
375 |
284 |
$7.36 |
| S0028 |
Injection, famotidine, 20 mg |
12 |
12 |
$0.00 |