| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J9271 |
Inj pembrolizumab |
1,139 |
939 |
$5.85M |
| J9299 |
Injection, nivolumab |
979 |
703 |
$5.14M |
| 96413 |
|
7,960 |
5,277 |
$1.98M |
| J0897 |
Denosumab injection |
1,397 |
1,313 |
$1.92M |
| J2506 |
Inj pegfilgrast ex bio 0.5mg |
394 |
289 |
$1.89M |
| 96375 |
|
5,578 |
3,204 |
$1.48M |
| 80053 |
|
20,442 |
14,706 |
$1.37M |
| 74177 |
|
1,188 |
1,180 |
$1.04M |
| 99199 |
|
1,407 |
952 |
$1.00M |
| J9217 |
Leuprolide acetate suspnsion |
710 |
701 |
$977K |
| 77386 |
|
734 |
66 |
$970K |
| 0250 |
|
4,383 |
2,604 |
$884K |
| J9035 |
Bevacizumab injection |
435 |
181 |
$872K |
| G0463 |
Hospital outpt clinic visit |
16,851 |
14,034 |
$856K |
| 71260 |
|
2,085 |
2,067 |
$774K |
| 85025 |
|
21,947 |
15,223 |
$690K |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
2,168 |
2,119 |
$508K |
| 74178 |
|
463 |
459 |
$436K |
| J1100 |
Dexamethasone sodium phos |
3,000 |
1,958 |
$428K |
| J9022 |
Inj, atezolizumab,10 mg |
112 |
92 |
$413K |
| J7050 |
Normal saline solution infus |
7,393 |
4,917 |
$382K |
| 96367 |
|
1,348 |
877 |
$355K |
| 96372 |
|
5,293 |
3,551 |
$314K |
| 96365 |
|
1,488 |
809 |
$297K |
| J1626 |
Granisetron hcl injection |
3,732 |
2,081 |
$275K |
| 77334 |
|
294 |
236 |
$266K |
| 83735 |
|
7,165 |
4,091 |
$232K |
| J2505 |
Injection, pegfilgrastim 6mg |
30 |
25 |
$231K |
| 0510 |
|
6,154 |
5,131 |
$216K |
| 96415 |
|
1,757 |
1,164 |
$204K |
| J1453 |
Fosaprepitant injection |
614 |
389 |
$182K |
| 0270 |
|
878 |
473 |
$177K |
| 0760 |
|
2,652 |
1,996 |
$173K |
| 96417 |
|
2,062 |
1,441 |
$166K |
| 77336 |
|
982 |
499 |
$164K |
| Q5107 |
Inj mvasi 10 mg |
197 |
92 |
$163K |
| 96416 |
|
949 |
592 |
$149K |
| 77300 |
|
361 |
325 |
$148K |
| J1642 |
Inj heparin sodium per 10 u |
5,194 |
2,538 |
$136K |
| 86900 |
|
2,613 |
1,361 |
$132K |
| 36415 |
|
8,233 |
6,662 |
$131K |
| 84100 |
|
6,373 |
3,556 |
$118K |
| J9144 |
Daratumumab, hyaluronidase |
23 |
13 |
$115K |
| 80197 |
|
1,558 |
886 |
$102K |
| 96361 |
|
918 |
618 |
$97K |
| 96411 |
|
986 |
684 |
$94K |
| 83615 |
|
4,747 |
3,189 |
$83K |
| J0885 |
Epoetin alfa, non-esrd |
626 |
249 |
$81K |
| P9040 |
Rbc leukoreduced irradiated |
212 |
132 |
$78K |
| 96401 |
|
757 |
331 |
$73K |
| Q3014 |
Telehealth facility fee |
3,688 |
3,437 |
$73K |
| 93306 |
|
71 |
70 |
$72K |
| 86850 |
|
2,357 |
1,183 |
$72K |
| J7060 |
5% dextrose/water |
2,365 |
1,404 |
$71K |
| J9190 |
Fluorouracil injection |
647 |
416 |
$69K |
| 87497 |
|
1,098 |
596 |
$64K |
| J0881 |
Darbepoetin alfa, non-esrd |
111 |
89 |
$61K |
| 84443 |
|
3,520 |
3,155 |
$60K |
| 77301 |
|
93 |
90 |
$55K |
| J9201 |
In gemcitabine hcl nos 200mg |
165 |
95 |
$55K |
| 96402 |
|
891 |
863 |
$55K |
| J1200 |
Diphenhydramine hcl injectio |
1,429 |
877 |
$52K |
| 96360 |
|
355 |
209 |
$51K |
| 82378 |
|
2,919 |
2,422 |
$50K |
| 86901 |
|
2,610 |
1,352 |
$47K |
| 85610 |
|
2,064 |
1,762 |
$46K |
| 74174 |
|
54 |
54 |
$42K |
| 77066 |
Tomosynthesis, mammo |
329 |
328 |
$36K |
| Z7500 |
|
1,050 |
752 |
$36K |
| 81001 |
|
2,116 |
1,952 |
$33K |
| 83521 |
|
822 |
678 |
$33K |
| 36430 |
|
104 |
63 |
$33K |
| 96374 |
|
244 |
155 |
$33K |
| 99203 |
|
262 |
217 |
$32K |
| 77338 |
|
112 |
104 |
$31K |
| 85730 |
|
1,288 |
1,133 |
$28K |
| 84153 |
|
1,644 |
1,564 |
$27K |
| 86301 |
|
1,600 |
1,264 |
$26K |
| 71250 |
|
132 |
131 |
$26K |
| 87799 |
|
676 |
430 |
$25K |
| J7030 |
Normal saline solution infus |
1,212 |
675 |
$24K |
| 82728 |
|
1,638 |
1,504 |
$20K |
| 84439 |
|
1,231 |
1,135 |
$18K |
| J7040 |
Normal saline solution infus |
745 |
494 |
$17K |
| 99212 |
|
438 |
367 |
$17K |
| 77067 |
|
331 |
325 |
$17K |
| 74176 |
|
39 |
38 |
$17K |
| 82105 |
|
738 |
656 |
$17K |
| 76642 |
|
127 |
126 |
$16K |
| G0279 |
Tomosynthesis, mammo |
283 |
282 |
$16K |
| 82306 |
|
1,028 |
994 |
$15K |
| J9263 |
Oxaliplatin |
171 |
61 |
$15K |
| 80048 |
|
769 |
715 |
$15K |
| 82784 |
|
479 |
405 |
$14K |
| 87086 |
|
729 |
703 |
$13K |
| 84165 |
|
875 |
756 |
$12K |
| 86920 |
|
77 |
51 |
$12K |
| 84403 |
|
772 |
722 |
$11K |
| 83540 |
|
1,623 |
1,501 |
$11K |
| 88305 |
|
172 |
151 |
$11K |
| 83036 |
|
1,333 |
1,303 |
$10K |
| 93005 |
|
101 |
85 |
$10K |
| 77063 |
|
305 |
300 |
$9K |
| 0272 |
|
401 |
258 |
$8K |
| 0710 |
|
47 |
42 |
$8K |
| 84550 |
|
652 |
517 |
$8K |
| 81479 |
|
42 |
36 |
$7K |
| 83550 |
|
1,609 |
1,488 |
$7K |
| 86803 |
|
360 |
335 |
$7K |
| 85027 |
|
598 |
576 |
$6K |
| 82565 |
|
160 |
152 |
$6K |
| 96366 |
|
103 |
68 |
$6K |
| 88321 |
|
178 |
171 |
$6K |
| 84155 |
|
466 |
427 |
$6K |
| 80061 |
|
1,074 |
1,061 |
$6K |
| 87340 |
|
433 |
407 |
$6K |
| 86334 |
|
144 |
128 |
$5K |
| J0640 |
Leucovorin calcium injection |
482 |
283 |
$5K |
| A9270 |
Non-covered item or service |
985 |
651 |
$4K |
| 82607 |
|
437 |
428 |
$4K |
| 86704 |
|
255 |
236 |
$4K |
| Z7610 |
|
293 |
126 |
$4K |
| 88108 |
|
75 |
73 |
$4K |
| 87077 |
|
365 |
358 |
$4K |
| 0370 |
|
13 |
12 |
$3K |
| 99070 |
|
139 |
89 |
$3K |
| 87186 |
|
217 |
213 |
$3K |
| 82570 |
|
530 |
503 |
$3K |
| 85045 |
|
203 |
194 |
$3K |
| 77080 |
|
26 |
26 |
$3K |
| 86300 |
|
419 |
383 |
$2K |
| 71046 |
|
13 |
13 |
$2K |
| 83880 |
|
149 |
135 |
$2K |
| 86140 |
|
270 |
249 |
$2K |
| 82746 |
|
295 |
288 |
$1K |
| 83970 |
|
53 |
53 |
$1K |
| 84156 |
|
292 |
266 |
$1K |
| J2704 |
Inj, propofol, 10 mg |
50 |
44 |
$1K |
| 86304 |
|
77 |
65 |
$1K |
| 83520 |
|
15 |
13 |
$1K |
| J9045 |
Carboplatin injection |
73 |
48 |
$1K |
| J3490 |
Drugs unclassified injection |
720 |
410 |
$913.59 |
| 86141 |
|
234 |
225 |
$911.40 |
| 80076 |
|
182 |
122 |
$859.92 |
| 80047 |
|
148 |
92 |
$784.29 |
| J2405 |
Ondansetron hcl injection |
45 |
37 |
$613.53 |
| 52000 |
|
12 |
12 |
$610.01 |
| 87624 |
|
13 |
13 |
$569.94 |
| 85652 |
|
349 |
342 |
$546.15 |
| 82043 |
|
219 |
216 |
$484.77 |
| 81003 |
|
119 |
90 |
$484.66 |
| 99231 |
|
15 |
14 |
$475.30 |
| 96377 |
|
48 |
36 |
$454.91 |
| J3420 |
Vitamin b12 injection |
123 |
117 |
$452.91 |
| 85379 |
|
25 |
24 |
$403.76 |
| 86644 |
|
17 |
13 |
$356.25 |
| 82550 |
|
19 |
16 |
$352.19 |
| 87801 |
|
12 |
12 |
$349.98 |
| 87389 |
|
27 |
27 |
$326.52 |
| 51798 |
|
13 |
13 |
$247.85 |
| 86317 |
|
89 |
88 |
$244.10 |
| 88142 |
|
26 |
26 |
$231.87 |
| 86769 |
|
15 |
13 |
$203.48 |
| J3010 |
Fentanyl citrate injection |
32 |
31 |
$137.68 |
| 82610 |
|
25 |
25 |
$110.74 |
| 82232 |
|
15 |
15 |
$14.41 |
| J2250 |
Inj midazolam hydrochloride |
14 |
13 |
$7.19 |
| J0461 |
Atropine sulfate injection |
62 |
37 |
$3.08 |