| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99284 |
|
19,348 |
16,908 |
$2.09M |
| 99283 |
|
21,602 |
19,455 |
$1.74M |
| 99285 |
|
3,107 |
2,682 |
$511K |
| 80053 |
|
21,914 |
17,851 |
$135K |
| G0378 |
Hospital observation per hr |
795 |
529 |
$112K |
| 99282 |
|
2,072 |
1,954 |
$112K |
| 87426 |
|
3,253 |
2,851 |
$95K |
| 85025 |
|
20,816 |
16,732 |
$90K |
| 71045 |
|
4,184 |
3,689 |
$82K |
| 80307 |
|
2,682 |
1,474 |
$68K |
| 93005 |
|
3,696 |
3,206 |
$63K |
| 71046 |
|
2,273 |
1,993 |
$53K |
| 87804 |
|
2,218 |
1,838 |
$50K |
| 87276 |
|
3,786 |
3,371 |
$46K |
| 36415 |
|
23,336 |
18,170 |
$38K |
| 87275 |
|
3,793 |
3,373 |
$36K |
| 58662 |
|
303 |
128 |
$36K |
| 70450 |
|
330 |
284 |
$35K |
| 95810 |
|
86 |
83 |
$31K |
| 87430 |
|
2,264 |
2,090 |
$29K |
| 96372 |
|
4,851 |
3,714 |
$26K |
| 43239 |
|
84 |
80 |
$24K |
| 66984 |
|
116 |
88 |
$22K |
| 81001 |
|
11,488 |
9,374 |
$22K |
| J1885 |
Ketorolac tromethamine inj |
5,151 |
4,179 |
$16K |
| 87081 |
|
1,902 |
1,724 |
$10K |
| 83880 |
|
498 |
424 |
$10K |
| 84484 |
|
1,489 |
1,259 |
$10K |
| 74176 |
|
43 |
38 |
$10K |
| 81025 |
|
1,538 |
1,334 |
$9K |
| 84702 |
|
1,351 |
932 |
$7K |
| 80050 |
|
183 |
160 |
$7K |
| M0243 |
Casirivi and imdevi inj |
22 |
17 |
$6K |
| 83735 |
|
1,672 |
1,367 |
$6K |
| J7030 |
Normal saline solution infus |
868 |
653 |
$6K |
| 87086 |
|
944 |
799 |
$5K |
| 80061 |
|
504 |
468 |
$5K |
| 96365 |
|
81 |
36 |
$5K |
| 82550 |
|
1,160 |
1,009 |
$4K |
| 87880 |
|
376 |
317 |
$4K |
| 00840 |
|
70 |
43 |
$4K |
| 84443 |
|
362 |
316 |
$4K |
| 99281 |
|
108 |
95 |
$4K |
| 83690 |
|
832 |
690 |
$4K |
| 94640 |
|
214 |
178 |
$3K |
| 87420 |
|
237 |
228 |
$3K |
| 83655 |
|
271 |
241 |
$3K |
| U0003 |
Cov-19 amp prb hgh thruput |
37 |
37 |
$3K |
| 87635 |
|
194 |
172 |
$3K |
| 93017 |
|
25 |
25 |
$2K |
| 85730 |
|
1,225 |
935 |
$2K |
| 76856 |
|
26 |
25 |
$2K |
| 96361 |
|
231 |
150 |
$2K |
| 86850 |
|
1,512 |
1,109 |
$2K |
| 83036 |
|
313 |
282 |
$2K |
| J0696 |
Ceftriaxone sodium injection |
465 |
390 |
$2K |
| 87491 |
|
74 |
65 |
$2K |
| 85610 |
|
1,409 |
1,085 |
$2K |
| 93306 |
|
26 |
25 |
$2K |
| 74019 |
|
97 |
86 |
$2K |
| 82553 |
|
341 |
288 |
$2K |
| 81003 |
|
1,326 |
1,128 |
$2K |
| 86803 |
|
236 |
185 |
$2K |
| 85027 |
|
290 |
252 |
$2K |
| 87280 |
|
128 |
123 |
$2K |
| 74018 |
|
72 |
60 |
$2K |
| J0690 |
Cefazolin sodium injection |
444 |
258 |
$2K |
| 96366 |
|
190 |
38 |
$2K |
| 86762 |
|
108 |
94 |
$1K |
| Q0162 |
Ondansetron oral |
127 |
118 |
$1K |
| 86901 |
|
1,566 |
1,152 |
$1K |
| 86900 |
|
1,532 |
1,126 |
$1K |
| 74021 |
|
61 |
60 |
$1K |
| J2405 |
Ondansetron hcl injection |
1,397 |
959 |
$1K |
| J2175 |
Meperidine hydrochl /100 mg |
1,572 |
1,159 |
$962.25 |
| 86706 |
|
92 |
80 |
$949.44 |
| 87340 |
|
95 |
82 |
$907.33 |
| J2704 |
Inj, propofol, 10 mg |
2,402 |
1,689 |
$832.21 |
| J7120 |
Ringers lactate infusion |
567 |
339 |
$753.84 |
| J3010 |
Fentanyl citrate injection |
1,335 |
887 |
$693.55 |
| 84146 |
|
33 |
32 |
$692.15 |
| 85007 |
|
289 |
251 |
$660.10 |
| 96360 |
|
30 |
30 |
$641.16 |
| 80048 |
|
316 |
239 |
$620.60 |
| 85379 |
|
118 |
96 |
$596.93 |
| 93970 |
|
12 |
12 |
$430.54 |
| 84100 |
|
498 |
371 |
$427.57 |
| 86592 |
|
394 |
294 |
$417.87 |
| J2001 |
Lidocaine injection |
1,899 |
1,227 |
$397.25 |
| J1100 |
Dexamethasone sodium phos |
785 |
559 |
$393.22 |
| 84403 |
|
12 |
12 |
$367.02 |
| 82627 |
|
12 |
12 |
$316.26 |
| 83001 |
|
13 |
13 |
$287.70 |
| 83002 |
|
13 |
13 |
$286.66 |
| 84144 |
|
12 |
12 |
$273.58 |
| 82306 |
|
13 |
13 |
$269.10 |
| 87040 |
|
51 |
27 |
$239.82 |
| J3490 |
Drugs unclassified injection |
196 |
92 |
$234.14 |
| 82150 |
|
30 |
29 |
$199.58 |
| J2250 |
Inj midazolam hydrochloride |
402 |
269 |
$190.89 |
| 84439 |
|
32 |
27 |
$183.47 |
| 86703 |
|
16 |
16 |
$179.70 |
| J2360 |
Orphenadrine injection |
15 |
14 |
$164.32 |
| J0780 |
Prochlorperazine injection |
14 |
12 |
$161.55 |
| 36416 |
|
120 |
88 |
$150.56 |
| 85018 |
|
73 |
59 |
$147.46 |
| 85014 |
|
73 |
59 |
$147.46 |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
100 |
78 |
$140.29 |
| J2800 |
Methocarbamol injection |
18 |
12 |
$137.79 |
| 87070 |
|
15 |
15 |
$129.57 |
| 87045 |
|
12 |
12 |
$127.60 |
| J2930 |
Methylprednisolone injection |
52 |
42 |
$123.02 |
| C1780 |
Lens, intraocular (new tech) |
70 |
51 |
$113.09 |
| 82043 |
|
18 |
16 |
$81.98 |
| 83605 |
|
14 |
12 |
$81.58 |
| J0702 |
Betamethasone acet&sod phosp |
13 |
12 |
$75.08 |
| 84703 |
|
48 |
35 |
$74.75 |
| 82570 |
|
18 |
16 |
$73.44 |
| 85652 |
|
44 |
33 |
$70.49 |
| 82962 |
|
38 |
24 |
$65.33 |
| J2550 |
Promethazine hcl injection |
268 |
162 |
$63.56 |
| 82009 |
|
18 |
13 |
$40.83 |
| 85384 |
|
34 |
29 |
$38.98 |
| C9399 |
Unclassified drugs or biolog |
22 |
14 |
$17.26 |
| 86593 |
|
17 |
16 |
$14.72 |
| J7512 |
Prednisone ir or dr oral 1mg |
13 |
13 |
$3.36 |
| 96127 |
|
922 |
434 |
$0.00 |
| A9270 |
Non-covered item or service |
423 |
363 |
$0.00 |
| 30140 |
|
19 |
14 |
$0.00 |
| J2003 |
Inj, lidocaine hcl, 1 mg |
36 |
32 |
$0.00 |
| 96374 |
|
14 |
12 |
$0.00 |
| J7050 |
Normal saline solution infus |
21 |
15 |
$0.00 |
| 0001A |
|
63 |
25 |
$0.00 |
| J2710 |
Neostigmine methylslfte inj |
87 |
27 |
$0.00 |
| 0002A |
|
60 |
23 |
$0.00 |