| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 0450 |
|
13,370 |
12,130 |
$297K |
| 0202U |
|
673 |
663 |
$102K |
| 99199 |
|
1,865 |
1,645 |
$93K |
| 87636 |
|
717 |
709 |
$60K |
| 93005 |
|
3,603 |
3,444 |
$38K |
| 80053 |
|
5,552 |
5,138 |
$27K |
| 87635 |
|
788 |
765 |
$27K |
| 74177 |
|
289 |
286 |
$26K |
| 96374 |
|
817 |
775 |
$23K |
| 85025 |
|
6,185 |
5,648 |
$21K |
| 87633 |
|
128 |
128 |
$18K |
| 71045 |
|
2,120 |
2,055 |
$15K |
| 96375 |
|
579 |
509 |
$12K |
| 96361 |
|
536 |
496 |
$8K |
| 84484 |
|
1,863 |
1,591 |
$7K |
| 70450 |
|
164 |
163 |
$6K |
| 83690 |
|
1,792 |
1,706 |
$6K |
| 96372 |
|
433 |
391 |
$6K |
| 81025 |
|
1,866 |
1,793 |
$5K |
| J7030 |
Normal saline solution infus |
1,451 |
1,282 |
$5K |
| 81001 |
|
2,790 |
2,670 |
$4K |
| 0241U |
|
223 |
222 |
$4K |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
1,089 |
755 |
$4K |
| J1885 |
Ketorolac tromethamine inj |
1,281 |
1,203 |
$4K |
| 87798 |
|
129 |
126 |
$4K |
| 74176 |
|
50 |
50 |
$3K |
| 87086 |
|
1,183 |
1,142 |
$3K |
| 99283 |
|
148 |
143 |
$3K |
| 87631 |
|
92 |
92 |
$3K |
| 71046 |
|
234 |
228 |
$2K |
| 81003 |
|
1,964 |
1,900 |
$2K |
| 80048 |
|
363 |
343 |
$2K |
| 94640 |
|
224 |
193 |
$2K |
| 87581 |
|
128 |
128 |
$2K |
| 87486 |
|
116 |
116 |
$2K |
| 83605 |
|
348 |
313 |
$2K |
| 87804 |
|
181 |
154 |
$1K |
| 99284 |
|
223 |
205 |
$1K |
| J2405 |
Ondansetron hcl injection |
1,040 |
926 |
$1K |
| 83880 |
|
61 |
57 |
$855.39 |
| 96360 |
|
41 |
38 |
$764.75 |
| 96365 |
|
19 |
16 |
$745.88 |
| 83735 |
|
209 |
193 |
$625.48 |
| J1170 |
Hydromorphone injection |
121 |
83 |
$436.45 |
| J2270 |
Morphine sulfate injection |
98 |
87 |
$386.56 |
| 87040 |
|
76 |
54 |
$379.70 |
| J0696 |
Ceftriaxone sodium injection |
110 |
106 |
$367.27 |
| 82553 |
|
48 |
45 |
$355.98 |
| J3490 |
Drugs unclassified injection |
106 |
89 |
$314.96 |
| 85610 |
|
169 |
167 |
$251.52 |
| 82550 |
|
60 |
57 |
$209.20 |
| 85379 |
|
39 |
39 |
$116.04 |
| 87880 |
|
24 |
24 |
$114.68 |
| U0005 |
Infec agen detec ampli probe |
12 |
12 |
$108.75 |
| 85730 |
|
36 |
36 |
$96.31 |
| J7120 |
Ringers lactate infusion |
42 |
42 |
$77.16 |
| 87081 |
|
12 |
12 |
$51.28 |
| J2765 |
Metoclopramide hcl injection |
14 |
12 |
$44.36 |
| J1200 |
Diphenhydramine hcl injectio |
13 |
12 |
$42.08 |
| 36415 |
|
80 |
66 |
$29.24 |
| 0270 |
|
34 |
26 |
$19.99 |
| J2272 |
Inj, morphine (fresenius) |
15 |
15 |
$12.34 |
| 87186 |
|
13 |
13 |
$8.69 |
| J7050 |
Normal saline solution infus |
29 |
15 |
$6.95 |
| A9270 |
Non-covered item or service |
23 |
16 |
$0.00 |
| J7040 |
Normal saline solution infus |
12 |
12 |
$0.00 |