| Code | Description | Claims | Beneficiaries | Total Paid |
| 92507 |
|
105,589 |
29,058 |
$27.15M |
| 99283 |
|
85,077 |
79,838 |
$19.00M |
| 97110 |
|
81,563 |
23,579 |
$13.90M |
| 99284 |
|
37,997 |
35,895 |
$11.00M |
| 97530 |
|
52,768 |
16,408 |
$8.43M |
| 93303 |
|
6,617 |
6,278 |
$4.79M |
| 93306 |
|
8,230 |
7,717 |
$4.57M |
| 80053 |
|
44,492 |
37,197 |
$4.35M |
| 99282 |
|
16,150 |
15,278 |
$3.30M |
| G0378 |
Hospital observation per hr |
11,896 |
5,436 |
$2.14M |
| 92523 |
|
8,450 |
8,176 |
$2.11M |
| 99285 |
|
7,565 |
7,011 |
$1.88M |
| 95810 |
|
1,734 |
1,674 |
$1.74M |
| U0003 |
Cov-19 amp prb hgh thruput |
17,210 |
16,303 |
$1.72M |
| J1569 |
Gammagard liquid injection |
801 |
437 |
$1.60M |
| 94375 |
|
11,372 |
10,911 |
$1.55M |
| 96365 |
|
3,521 |
2,844 |
$1.54M |
| T1017 |
Targeted case management |
59,906 |
29,031 |
$1.53M |
| 92526 |
|
11,875 |
5,463 |
$1.49M |
| 70551 |
|
4,796 |
4,466 |
$1.16M |
| 95782 |
|
973 |
940 |
$966K |
| 54161 |
|
1,060 |
1,018 |
$721K |
| 87086 |
|
14,836 |
13,857 |
$708K |
| 97162 |
|
2,107 |
2,033 |
$690K |
| 82657 |
|
3,014 |
2,040 |
$665K |
| J1745 |
Infliximab not biosimil 10mg |
631 |
552 |
$662K |
| 70450 |
|
2,940 |
2,788 |
$647K |
| 96374 |
|
6,224 |
5,350 |
$629K |
| 87804 |
|
11,198 |
10,770 |
$624K |
| 96360 |
|
3,659 |
3,123 |
$621K |
| 92610 |
|
2,778 |
2,337 |
$619K |
| 70553 |
|
2,514 |
2,185 |
$603K |
| 93005 |
|
24,246 |
22,707 |
$599K |
| 76770 |
|
3,481 |
3,309 |
$590K |
| 97161 |
|
2,507 |
2,391 |
$575K |
| 92579 |
|
3,752 |
3,552 |
$574K |
| 42820 |
|
823 |
772 |
$559K |
| 88305 |
|
3,789 |
3,229 |
$553K |
| 93304 |
|
818 |
783 |
$530K |
| 96375 |
|
4,442 |
3,503 |
$519K |
| 87633 |
|
4,692 |
4,388 |
$518K |
| 01922 |
|
1,337 |
1,210 |
$514K |
| 71046 |
|
12,912 |
12,065 |
$494K |
| T1024 |
Team evaluation & management |
3,968 |
3,743 |
$487K |
| A9585 |
Gadobutrol injection |
3,598 |
3,127 |
$452K |
| 96361 |
|
3,303 |
2,728 |
$451K |
| 97166 |
|
1,522 |
1,494 |
$430K |
| 81025 |
|
8,444 |
7,633 |
$428K |
| J0585 |
Injection,onabotulinumtoxina |
565 |
542 |
$424K |
| 76825 |
|
1,196 |
1,099 |
$415K |
| J7060 |
5% dextrose/water |
1,130 |
578 |
$411K |
| 85025 |
|
47,860 |
40,749 |
$408K |
| 43239 |
|
1,960 |
1,812 |
$398K |
| 74230 |
|
1,710 |
1,617 |
$381K |
| 97165 |
|
1,363 |
1,333 |
$377K |
| 80048 |
|
5,230 |
4,744 |
$366K |
| 93308 |
|
774 |
731 |
$353K |
| 0202U |
|
1,031 |
1,011 |
$345K |
| 94640 |
|
8,692 |
6,037 |
$334K |
| 76705 |
|
5,684 |
5,278 |
$329K |
| 96413 |
|
2,741 |
1,902 |
$318K |
| 88304 |
|
5,576 |
5,155 |
$313K |
| 95819 |
|
893 |
864 |
$298K |
| 97755 |
|
1,306 |
872 |
$295K |
| 87635 |
|
2,543 |
2,387 |
$290K |
| 84443 |
|
11,777 |
11,237 |
$289K |
| C1713 |
Anchor/screw bn/bn,tis/bn |
561 |
520 |
$281K |
| 87081 |
|
5,266 |
4,979 |
$278K |
| 86850 |
|
2,211 |
1,687 |
$267K |
| 92588 |
|
1,930 |
1,802 |
$259K |
| 87637 |
|
10,589 |
10,367 |
$258K |
| 87070 |
|
5,915 |
5,566 |
$250K |
| 96372 |
|
1,892 |
1,669 |
$250K |
| J7050 |
Normal saline solution infus |
1,555 |
1,056 |
$239K |
| 93975 |
|
1,274 |
1,192 |
$226K |
| 97164 |
|
853 |
828 |
$220K |
| 93325 |
|
9,635 |
9,077 |
$199K |
| 92557 |
|
892 |
851 |
$193K |
| 81229 |
|
380 |
341 |
$192K |
| 70360 |
|
2,328 |
2,267 |
$189K |
| 97802 |
|
824 |
779 |
$186K |
| 74177 |
|
458 |
429 |
$185K |
| 82784 |
|
5,276 |
4,252 |
$181K |
| 87507 |
|
673 |
624 |
$180K |
| 74018 |
|
3,616 |
3,380 |
$180K |
| 80195 |
|
1,125 |
782 |
$174K |
| 92552 |
|
1,564 |
1,473 |
$173K |
| 92555 |
|
5,690 |
5,316 |
$172K |
| 97542 |
|
1,323 |
836 |
$170K |
| 92524 |
|
572 |
561 |
$168K |
| 82306 |
|
6,520 |
6,182 |
$162K |
| 97168 |
|
924 |
899 |
$162K |
| Q9966 |
Locm 200-299mg/ml iodine,1ml |
1,491 |
1,234 |
$156K |
| 95816 |
|
400 |
386 |
$156K |
| 69436 |
|
954 |
894 |
$151K |
| 76536 |
|
1,093 |
1,034 |
$151K |
| 92586 |
|
1,024 |
728 |
$148K |
| 95811 |
|
162 |
157 |
$148K |
| 82785 |
|
3,432 |
3,306 |
$148K |
| 82962 |
|
3,677 |
2,911 |
$143K |
| 92651 |
|
1,034 |
962 |
$140K |
| 82728 |
|
5,312 |
4,858 |
$139K |
| 76377 |
|
1,976 |
1,848 |
$137K |
| 81001 |
|
20,951 |
19,526 |
$136K |
| 44970 |
|
69 |
67 |
$133K |
| 92593 |
|
2,405 |
2,164 |
$132K |
| 42830 |
|
370 |
338 |
$130K |
| 92582 |
|
974 |
899 |
$130K |
| 77072 |
|
1,536 |
1,477 |
$128K |
| 86003 |
|
3,507 |
3,343 |
$128K |
| 89051 |
|
764 |
624 |
$125K |
| 97803 |
|
538 |
519 |
$122K |
| 88300 |
|
2,465 |
2,238 |
$121K |
| 76885 |
|
598 |
569 |
$119K |
| 85027 |
|
11,013 |
8,402 |
$117K |
| 73090 |
|
1,863 |
1,708 |
$117K |
| 76700 |
|
625 |
612 |
$114K |
| 74019 |
|
5,224 |
4,931 |
$114K |
| J2704 |
Inj, propofol, 10 mg |
20,030 |
16,918 |
$114K |
| 82565 |
|
1,170 |
1,055 |
$110K |
| 92630 |
|
2,015 |
695 |
$108K |
| 95715 |
|
104 |
86 |
$103K |
| 36430 |
|
702 |
499 |
$94K |
| 73721 |
|
279 |
265 |
$93K |
| 96415 |
|
1,142 |
941 |
$92K |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
924 |
816 |
$88K |
| 82746 |
|
1,208 |
1,166 |
$83K |
| 73610 |
|
1,750 |
1,623 |
$82K |
| 85007 |
|
10,475 |
7,900 |
$79K |
| 73630 |
|
1,893 |
1,788 |
$77K |
| 70486 |
|
649 |
622 |
$76K |
| 95714 |
|
339 |
281 |
$76K |
| 45380 |
|
177 |
170 |
$76K |
| Q0162 |
Ondansetron oral |
15,760 |
14,683 |
$75K |
| 71045 |
|
2,216 |
2,016 |
$74K |
| 92567 |
|
8,046 |
7,507 |
$71K |
| Q5104 |
Injection, renflexis |
31 |
25 |
$70K |
| 73070 |
|
1,042 |
914 |
$69K |
| 73140 |
|
1,090 |
1,046 |
$69K |
| 92620 |
|
235 |
222 |
$68K |
| V5264 |
Ear mold/insert |
737 |
716 |
$68K |
| 80069 |
|
1,512 |
1,163 |
$67K |
| 70250 |
|
660 |
619 |
$65K |
| 82272 |
|
1,321 |
1,189 |
$65K |
| 74240 |
|
365 |
352 |
$63K |
| 67311 |
|
55 |
54 |
$61K |
| 87631 |
|
3,217 |
2,746 |
$60K |
| 92553 |
|
394 |
347 |
$59K |
| 86140 |
|
10,879 |
9,585 |
$59K |
| 84439 |
|
9,799 |
9,342 |
$58K |
| 73560 |
|
1,650 |
1,515 |
$58K |
| 73130 |
|
1,211 |
1,131 |
$57K |
| 86923 |
|
735 |
570 |
$56K |
| 87077 |
|
4,772 |
4,497 |
$54K |
| 96409 |
|
823 |
541 |
$54K |
| 0001U |
|
118 |
113 |
$54K |
| 92585 |
|
446 |
377 |
$53K |
| 92592 |
|
1,012 |
911 |
$52K |
| 87420 |
|
523 |
494 |
$51K |
| 80061 |
|
4,155 |
3,988 |
$51K |
| 73590 |
|
1,239 |
1,123 |
$47K |
| J7030 |
Normal saline solution infus |
11,264 |
8,766 |
$47K |
| 80306 |
|
1,713 |
1,578 |
$47K |
| 87186 |
|
3,575 |
3,386 |
$46K |
| 14040 |
|
77 |
69 |
$45K |
| 82607 |
|
1,189 |
1,149 |
$45K |
| 82805 |
|
1,555 |
1,410 |
$45K |
| J1459 |
Inj ivig privigen 500 mg |
119 |
70 |
$45K |
| J1100 |
Dexamethasone sodium phos |
11,252 |
10,062 |
$44K |
| 87799 |
|
2,577 |
1,835 |
$43K |
| 12011 |
|
960 |
936 |
$43K |
| 86317 |
|
1,433 |
1,072 |
$42K |
| 99281 |
|
277 |
265 |
$42K |
| 83520 |
|
800 |
724 |
$42K |
| 00170 |
|
1,204 |
1,074 |
$40K |
| 96376 |
|
178 |
154 |
$40K |
| 76856 |
|
339 |
320 |
$40K |
| 76870 |
|
298 |
282 |
$40K |
| 72082 |
|
439 |
414 |
$40K |
| 92652 |
|
485 |
460 |
$39K |
| 72141 |
|
520 |
474 |
$39K |
| Q9958 |
Hocm <=149 mg/ml iodine, 1ml |
346 |
308 |
$39K |
| 80076 |
|
1,231 |
1,165 |
$39K |
| 72148 |
|
629 |
577 |
$38K |
| 83993 |
|
833 |
793 |
$38K |
| 80074 |
|
360 |
342 |
$37K |
| 93226 |
|
869 |
836 |
$37K |
| 85046 |
|
3,022 |
2,688 |
$37K |
| 96450 |
|
261 |
199 |
$37K |
| 82085 |
|
462 |
427 |
$37K |
| 74455 |
|
191 |
185 |
$35K |
| 87486 |
|
1,988 |
1,868 |
$35K |
| 72146 |
|
279 |
247 |
$34K |
| 95951 |
|
302 |
236 |
$34K |
| 72170 |
|
695 |
670 |
$33K |
| 96366 |
|
1,266 |
1,049 |
$32K |
| 00120 |
|
155 |
152 |
$31K |
| C1725 |
Cath, translumin non-laser |
32 |
30 |
$30K |
| 83880 |
|
2,242 |
1,815 |
$30K |
| 92587 |
|
2,201 |
2,053 |
$30K |
| 73521 |
|
331 |
322 |
$29K |
| 82043 |
|
667 |
639 |
$29K |
| 95700 |
|
646 |
608 |
$29K |
| 41899 |
|
525 |
410 |
$29K |
| 83498 |
|
631 |
606 |
$29K |
| 00920 |
|
566 |
529 |
$27K |
| J1885 |
Ketorolac tromethamine inj |
6,439 |
5,238 |
$27K |
| 73552 |
|
562 |
510 |
$26K |
| 87880 |
|
5,306 |
5,065 |
$26K |
| 73030 |
|
330 |
306 |
$26K |
| C1769 |
Guide wire |
505 |
449 |
$26K |
| 82948 |
|
787 |
679 |
$24K |
| 71260 |
|
84 |
81 |
$24K |
| 72040 |
|
477 |
455 |
$24K |
| 85652 |
|
9,286 |
8,397 |
$23K |
| J3490 |
Drugs unclassified injection |
10,150 |
6,492 |
$23K |
| 92550 |
|
937 |
874 |
$23K |
| 82247 |
|
767 |
489 |
$23K |
| 84510 |
|
580 |
407 |
$23K |
| 87491 |
|
2,315 |
2,150 |
$22K |
| 73110 |
|
482 |
452 |
$22K |
| 87045 |
|
919 |
882 |
$22K |
| 93320 |
|
6,521 |
6,179 |
$22K |
| 93225 |
|
1,166 |
1,122 |
$21K |
| 93242 |
|
769 |
735 |
$20K |
| 87400 |
|
321 |
307 |
$20K |
| 87046 |
|
919 |
882 |
$20K |
| 86235 |
|
468 |
399 |
$20K |
| 83516 |
|
1,121 |
1,069 |
$20K |
| 76882 |
|
322 |
288 |
$19K |
| V5010 |
Assessment for hearing aid |
500 |
494 |
$16K |
| 76000 |
|
585 |
513 |
$16K |
| 80329 |
|
265 |
180 |
$16K |
| 00300 |
|
223 |
206 |
$15K |
| 82330 |
|
1,963 |
1,667 |
$15K |
| 87591 |
|
2,314 |
2,150 |
$15K |
| 83970 |
|
955 |
885 |
$14K |
| J8540 |
Oral dexamethasone |
9,298 |
6,947 |
$14K |
| 12001 |
|
439 |
426 |
$13K |
| T2101 |
Breast milk proc/store/dist |
13 |
12 |
$13K |
| 93976 |
|
863 |
806 |
$13K |
| J9370 |
Vincristine sulfate 1 mg inj |
1,366 |
888 |
$13K |
| 83021 |
|
933 |
747 |
$13K |
| J2001 |
Lidocaine injection |
8,897 |
7,563 |
$13K |
| 83020 |
|
1,995 |
1,642 |
$12K |
| 94060 |
|
73 |
73 |
$12K |
| 82570 |
|
2,516 |
2,324 |
$11K |
| 94799 |
|
750 |
615 |
$11K |
| 84146 |
|
497 |
479 |
$11K |
| 84446 |
|
165 |
160 |
$11K |
| 82550 |
|
1,957 |
1,775 |
$11K |
| 86355 |
|
1,368 |
1,255 |
$11K |
| 85610 |
|
3,672 |
3,192 |
$11K |
| 76881 |
|
119 |
101 |
$10K |
| 84702 |
|
610 |
565 |
$10K |
| J0690 |
Cefazolin sodium injection |
4,096 |
3,365 |
$10K |
| J2405 |
Ondansetron hcl injection |
6,054 |
4,670 |
$10K |
| 88312 |
|
1,082 |
974 |
$10K |
| 84484 |
|
667 |
619 |
$10K |
| 82397 |
|
916 |
869 |
$10K |
| 83690 |
|
3,713 |
3,421 |
$10K |
| 83615 |
|
1,980 |
1,597 |
$9K |
| 84466 |
|
3,226 |
3,032 |
$9K |
| 87040 |
|
4,472 |
4,034 |
$9K |
| 00812 |
|
118 |
118 |
$9K |
| 83540 |
|
3,324 |
3,132 |
$9K |
| 54640 |
|
30 |
29 |
$8K |
| 83036 |
|
3,720 |
3,510 |
$8K |
| 80197 |
|
2,658 |
1,630 |
$8K |
| 84403 |
|
1,302 |
1,257 |
$8K |
| 94770 |
|
28 |
24 |
$8K |
| 83735 |
|
6,618 |
4,695 |
$8K |
| 86902 |
|
28 |
24 |
$8K |
| 84703 |
|
874 |
806 |
$8K |
| 70480 |
|
44 |
44 |
$8K |
| 94762 |
|
757 |
572 |
$8K |
| 86592 |
|
710 |
670 |
$8K |
| 00813 |
|
395 |
357 |
$8K |
| 72100 |
|
275 |
263 |
$8K |
| 82670 |
|
626 |
608 |
$7K |
| 81408 |
|
19 |
14 |
$7K |
| 93017 |
|
31 |
29 |
$7K |
| 70543 |
|
40 |
38 |
$7K |
| 70210 |
|
95 |
94 |
$7K |
| L4350 |
Ankle control ortho pre ots |
75 |
72 |
$7K |
| 82140 |
|
265 |
232 |
$7K |
| 80349 |
|
266 |
248 |
$7K |
| 0279U |
|
53 |
50 |
$7K |
| 92604 |
|
117 |
107 |
$6K |
| 82787 |
|
104 |
100 |
$6K |
| 87184 |
|
684 |
655 |
$6K |
| 92595 |
|
1,360 |
1,229 |
$6K |
| 83655 |
|
291 |
285 |
$6K |
| 82533 |
|
760 |
724 |
$6K |
| P9016 |
Rbc leukocytes reduced |
134 |
54 |
$6K |
| 85246 |
|
442 |
411 |
$6K |
| 82105 |
|
161 |
155 |
$6K |
| 86900 |
|
2,209 |
1,688 |
$6K |
| 76827 |
|
1,163 |
1,068 |
$6K |
| 84305 |
|
1,345 |
1,284 |
$5K |
| Q0163 |
Diphenhydramine hcl 50mg |
2,926 |
2,583 |
$5K |
| J1642 |
Inj heparin sodium per 10 u |
4,473 |
2,175 |
$5K |
| J2710 |
Neostigmine methylslfte inj |
1,295 |
1,181 |
$5K |
| 71250 |
|
21 |
21 |
$5K |
| 84100 |
|
4,787 |
3,616 |
$5K |
| 87497 |
|
2,577 |
1,876 |
$5K |
| 43762 |
|
17 |
16 |
$4K |
| 82024 |
|
130 |
126 |
$4K |
| 73060 |
|
105 |
96 |
$4K |
| 82947 |
|
1,529 |
1,413 |
$4K |
| 76010 |
|
34 |
29 |
$4K |
| L1830 |
Ko immob canvas long pre ots |
55 |
54 |
$4K |
| 72070 |
|
102 |
95 |
$4K |
| 89230 |
|
44 |
38 |
$4K |
| B4087 |
Gastro/jejuno tube, std |
129 |
111 |
$4K |
| 76857 |
|
36 |
29 |
$4K |
| 94642 |
|
56 |
53 |
$4K |
| 87116 |
|
98 |
94 |
$4K |
| 77080 |
|
33 |
32 |
$4K |
| 00140 |
|
207 |
189 |
$4K |
| 24640 |
|
24 |
24 |
$4K |
| J7040 |
Normal saline solution infus |
4,576 |
2,804 |
$4K |
| 87798 |
|
2,003 |
1,880 |
$4K |
| J3010 |
Fentanyl citrate injection |
6,575 |
4,760 |
$4K |
| 86255 |
|
629 |
593 |
$4K |
| 36415 |
|
57 |
53 |
$3K |
| 85014 |
|
1,568 |
1,437 |
$3K |
| 85240 |
|
573 |
511 |
$3K |
| 73000 |
|
29 |
26 |
$3K |
| 36591 |
|
366 |
210 |
$3K |
| 86480 |
|
269 |
256 |
$3K |
| 84436 |
|
1,020 |
997 |
$3K |
| 82040 |
|
71 |
70 |
$3K |
| 83605 |
|
1,819 |
1,650 |
$3K |
| 86803 |
|
199 |
191 |
$3K |
| 72125 |
|
12 |
12 |
$3K |
| 85045 |
|
4,858 |
4,158 |
$3K |
| 86160 |
|
1,487 |
1,382 |
$3K |
| 88313 |
|
390 |
319 |
$3K |
| J0697 |
Sterile cefuroxime injection |
106 |
101 |
$3K |
| 93321 |
|
1,284 |
1,230 |
$3K |
| 86038 |
|
1,316 |
1,233 |
$3K |
| J1644 |
Inj heparin sodium per 1000u |
1,629 |
289 |
$3K |
| 85730 |
|
2,623 |
2,384 |
$2K |
| 82627 |
|
1,030 |
987 |
$2K |
| 00126 |
|
144 |
131 |
$2K |
| 73660 |
|
45 |
42 |
$2K |
| 96411 |
|
347 |
199 |
$2K |
| 29125 |
|
107 |
106 |
$2K |
| 84030 |
|
581 |
407 |
$2K |
| 86901 |
|
2,208 |
1,687 |
$2K |
| J0171 |
Adrenalin epinephrine inject |
363 |
323 |
$2K |
| 92594 |
|
519 |
497 |
$2K |
| 74270 |
|
13 |
13 |
$2K |
| 92556 |
|
753 |
710 |
$2K |
| 81479 |
|
160 |
136 |
$2K |
| 87581 |
|
1,992 |
1,872 |
$2K |
| 87205 |
|
4,598 |
4,385 |
$2K |
| 80320 |
|
129 |
120 |
$2K |
| 87389 |
|
681 |
653 |
$2K |
| J0696 |
Ceftriaxone sodium injection |
3,156 |
2,573 |
$2K |
| 83519 |
|
56 |
54 |
$2K |
| J1720 |
Hydrocortisone sodium succ i |
1,252 |
998 |
$2K |
| 83001 |
|
1,072 |
1,032 |
$2K |
| J2795 |
Ropivacaine hcl injection |
1,739 |
1,590 |
$2K |
| J0665 |
Inj, bupivacaine, nos, 0.5mg |
127 |
114 |
$2K |
| 82375 |
|
1,454 |
1,330 |
$2K |
| 85018 |
|
1,753 |
1,588 |
$2K |
| 00635 |
|
123 |
97 |
$2K |
| 82977 |
|
2,044 |
1,814 |
$2K |
| 86665 |
|
178 |
171 |
$2K |
| P9041 |
Albumin (human),5%, 50ml |
63 |
52 |
$2K |
| 93356 |
|
954 |
870 |
$2K |
| 86360 |
|
1,325 |
1,215 |
$2K |
| 86359 |
|
1,375 |
1,255 |
$1K |
| J2250 |
Inj midazolam hydrochloride |
2,442 |
2,187 |
$1K |
| 92570 |
|
84 |
81 |
$1K |
| 80143 |
|
310 |
283 |
$1K |
| 82139 |
|
220 |
216 |
$1K |
| 84402 |
|
179 |
173 |
$1K |
| 86357 |
|
1,368 |
1,253 |
$1K |
| 87220 |
|
491 |
470 |
$1K |
| 84295 |
|
1,377 |
1,247 |
$1K |
| J2997 |
Alteplase recombinant |
38 |
14 |
$1K |
| 86880 |
|
59 |
54 |
$1K |
| 92621 |
|
192 |
188 |
$1K |
| 77085 |
|
12 |
12 |
$1K |
| 81403 |
|
58 |
53 |
$1K |
| 69210 |
|
13 |
13 |
$1K |
| 84590 |
|
179 |
172 |
$1K |
| 87641 |
|
348 |
335 |
$995.54 |
| 84132 |
|
1,444 |
1,310 |
$982.99 |
| 86162 |
|
1,182 |
1,083 |
$936.45 |
| 84156 |
|
1,448 |
1,319 |
$926.62 |
| 80164 |
|
135 |
123 |
$925.12 |
| 86308 |
|
138 |
132 |
$916.66 |
| 93270 |
|
24 |
24 |
$915.20 |
| 83002 |
|
1,179 |
1,136 |
$905.32 |
| V5261 |
Hearing aid, digit, bin, bte |
15 |
15 |
$862.88 |
| 90686 |
|
122 |
109 |
$841.96 |
| 88342 |
|
905 |
801 |
$826.17 |
| 77073 |
|
14 |
13 |
$819.39 |
| 70491 |
|
14 |
13 |
$817.02 |
| 83050 |
|
1,451 |
1,324 |
$774.95 |
| 82150 |
|
848 |
756 |
$767.50 |
| J2270 |
Morphine sulfate injection |
2,238 |
1,794 |
$766.97 |
| 82248 |
|
847 |
558 |
$730.99 |
| 76830 |
|
27 |
27 |
$724.43 |
| 92602 |
|
15 |
12 |
$682.66 |
| 86341 |
|
83 |
67 |
$669.88 |
| 88230 |
|
69 |
62 |
$668.19 |
| 86376 |
|
1,750 |
1,683 |
$644.52 |
| 51600 |
|
70 |
66 |
$635.66 |
| 84550 |
|
956 |
864 |
$634.51 |
| 86648 |
|
691 |
650 |
$604.79 |
| 73502 |
|
12 |
12 |
$601.39 |
| 93971 |
|
27 |
25 |
$600.86 |
| 84480 |
|
721 |
706 |
$582.90 |
| 83919 |
|
28 |
26 |
$580.47 |
| J1200 |
Diphenhydramine hcl injectio |
1,178 |
840 |
$561.19 |
| 29105 |
|
32 |
29 |
$555.36 |
| J7042 |
5% dextrose/normal saline |
2,184 |
1,528 |
$531.84 |
| 87449 |
|
12 |
12 |
$531.00 |
| 77074 |
|
12 |
12 |
$528.59 |
| 82435 |
|
1,269 |
1,167 |
$499.55 |
| V5160 |
Dispensing fee binaural |
12 |
12 |
$454.26 |
| 87338 |
|
276 |
262 |
$442.91 |
| 00731 |
|
86 |
77 |
$417.98 |
| J2930 |
Methylprednisolone injection |
423 |
322 |
$401.78 |
| 92583 |
|
12 |
12 |
$395.19 |
| 88184 |
|
66 |
52 |
$362.41 |
| 85576 |
|
12 |
12 |
$350.72 |
| J1596 |
Inj, glycopyrrolate, 0.1 mg |
13 |
13 |
$339.32 |
| 86356 |
|
114 |
111 |
$333.92 |
| J9260 |
Inj methotrexate sodium 50mg |
281 |
192 |
$326.78 |
| 80177 |
|
127 |
121 |
$323.51 |
| 80169 |
|
32 |
24 |
$306.08 |
| 86364 |
|
314 |
304 |
$289.61 |
| 84270 |
|
433 |
415 |
$286.97 |
| 82310 |
|
161 |
136 |
$276.86 |
| 82652 |
|
46 |
44 |
$269.54 |
| 86800 |
|
1,358 |
1,302 |
$262.07 |
| 87535 |
|
43 |
38 |
$242.34 |
| J0780 |
Prochlorperazine injection |
586 |
526 |
$240.44 |
| 88341 |
|
181 |
147 |
$235.72 |
| 82270 |
|
100 |
93 |
$235.19 |
| 82379 |
|
70 |
67 |
$229.61 |
| 82820 |
|
1,011 |
896 |
$222.67 |
| 29515 |
|
30 |
27 |
$218.67 |
| 83918 |
|
13 |
13 |
$213.66 |
| 82010 |
|
164 |
127 |
$213.64 |
| 94726 |
|
126 |
116 |
$212.16 |
| Q0144 |
Azithromycin dihydrate, oral |
376 |
327 |
$208.38 |
| 85379 |
|
338 |
299 |
$200.99 |
| 86774 |
|
712 |
671 |
$173.65 |
| 83525 |
|
246 |
233 |
$159.32 |
| 87181 |
|
358 |
342 |
$155.79 |
| 85397 |
|
246 |
231 |
$154.07 |
| 85384 |
|
394 |
352 |
$149.88 |
| 87206 |
|
189 |
181 |
$149.86 |
| 92611 |
|
393 |
378 |
$136.51 |
| 88185 |
|
15 |
14 |
$121.99 |
| U0005 |
Infec agen detec ampli probe |
6,557 |
6,286 |
$116.90 |
| 80183 |
|
29 |
29 |
$110.70 |
| 84460 |
|
53 |
52 |
$101.60 |
| 87075 |
|
29 |
27 |
$101.24 |
| 86008 |
|
27 |
26 |
$96.84 |
| 87328 |
|
410 |
368 |
$94.47 |
| 84478 |
|
354 |
192 |
$91.40 |
| 86039 |
|
71 |
65 |
$82.32 |
| 87529 |
|
14 |
13 |
$79.95 |
| 00400 |
|
65 |
53 |
$79.82 |
| 87177 |
|
321 |
295 |
$75.05 |
| 94729 |
|
24 |
24 |
$64.79 |
| 86664 |
|
178 |
171 |
$62.23 |
| 86225 |
|
403 |
379 |
$50.92 |
| L8699 |
Prosthetic implant nos |
295 |
279 |
$50.20 |
| 86430 |
|
79 |
78 |
$49.21 |
| 00840 |
|
84 |
78 |
$42.45 |
| 87329 |
|
352 |
312 |
$41.27 |
| 88311 |
|
27 |
26 |
$33.44 |
| 86663 |
|
52 |
50 |
$29.79 |
| 31233 |
|
122 |
111 |
$26.86 |
| 85247 |
|
16 |
15 |
$26.22 |
| J0131 |
Inj, acetaminophen (nos) |
705 |
630 |
$25.10 |
| 87210 |
|
49 |
48 |
$25.10 |
| J9250 |
Methotrexate sodium inj |
360 |
212 |
$25.09 |
| 84481 |
|
39 |
38 |
$23.73 |
| 0011A |
|
12 |
12 |
$16.94 |
| 84630 |
|
84 |
77 |
$15.07 |
| 86644 |
|
46 |
40 |
$14.35 |
| J7510 |
Prednisolone oral per 5 mg |
67 |
57 |
$14.15 |
| 85613 |
|
27 |
25 |
$13.45 |
| J2274 |
Inj morphine pf epid ithc |
1,505 |
1,075 |
$12.94 |
| 84450 |
|
13 |
13 |
$10.24 |
| 82438 |
|
57 |
38 |
$7.06 |
| J3480 |
Inj potassium chloride |
821 |
634 |
$0.00 |
| 82945 |
|
13 |
12 |
$0.00 |
| 88307 |
|
16 |
12 |
$0.00 |
| J3535 |
Metered dose inhaler drug |
1,886 |
1,574 |
$0.00 |
| J0610 |
Calcium glucon (fresenius) |
39 |
24 |
$0.00 |
| J7121 |
5% dextrose in lac ringers |
219 |
171 |
$0.00 |
| J1170 |
Hydromorphone injection |
145 |
124 |
$0.00 |
| 81268 |
|
27 |
26 |
$0.00 |
| 82077 |
|
161 |
150 |
$0.00 |
| J2370 |
Phenylephrine hcl injection |
19 |
17 |
$0.00 |
| 86777 |
|
15 |
13 |
$0.00 |
| A9270 |
Non-covered item or service |
32 |
28 |
$0.00 |
| J2920 |
Methylprednisolone injection |
127 |
96 |
$0.00 |
| 84410 |
|
89 |
85 |
$0.00 |
| 72158 |
|
13 |
12 |
$0.00 |
| 82390 |
|
13 |
13 |
$0.00 |
| 94761 |
|
15 |
13 |
$0.00 |
| J0330 |
Succinycholine chloride inj |
14 |
13 |
$0.00 |
| 86778 |
|
15 |
13 |
$0.00 |
| Q9963 |
Hocm 350-399mg/ml iodine,1ml |
45 |
36 |
$0.00 |
| 81374 |
|
12 |
12 |
$0.00 |
| 94760 |
|
18 |
16 |
$0.00 |
| 84157 |
|
13 |
12 |
$0.00 |
| 80179 |
|
239 |
220 |
$0.00 |
| 81267 |
|
40 |
38 |
$0.00 |
| J7070 |
D5w infusion |
410 |
214 |
$0.00 |
| A4649 |
Surgical supplies |
121 |
109 |
$0.00 |
| C1894 |
Intro/sheath, non-laser |
134 |
123 |
$0.00 |
| 81406 |
|
30 |
25 |
$0.00 |
| 85347 |
|
39 |
25 |
$0.00 |
| J1756 |
Iron sucrose injection |
210 |
89 |
$0.00 |
| 76942 |
|
45 |
42 |
$0.00 |
| 87102 |
|
45 |
41 |
$0.00 |
| J3475 |
Inj magnesium sulfate |
45 |
42 |
$0.00 |
| J1953 |
Levetiracetam injection |
64 |
52 |
$0.00 |
| 97129 |
|
62 |
27 |
$0.00 |
| 84145 |
|
43 |
41 |
$0.00 |
| J8499 |
Oral prescrip drug non chemo |
22 |
13 |
$0.00 |
| 80307 |
|
59 |
43 |
$0.00 |
| 81405 |
|
13 |
13 |
$0.00 |
| 94681 |
|
15 |
13 |
$0.00 |
| J3262 |
Tocilizumab injection |
17 |
13 |
$0.00 |
| 81404 |
|
19 |
15 |
$0.00 |
| 86200 |
|
12 |
12 |
$0.00 |