| Code | Description | Claims | Beneficiaries | Total Paid |
| G0463 |
Hospital outpt clinic visit |
337,799 |
264,226 |
$8.59M |
| 99213 |
|
91,891 |
87,533 |
$3.04M |
| 0450 |
|
33,368 |
28,728 |
$2.44M |
| 99214 |
|
64,595 |
61,845 |
$2.41M |
| 59425 |
|
30,897 |
24,908 |
$2.23M |
| 99285 |
|
3,886 |
3,322 |
$1.65M |
| Z7500 |
|
41,577 |
37,114 |
$1.40M |
| Z7502 |
|
36,067 |
35,500 |
$1.35M |
| Q3014 |
Telehealth facility fee |
42,870 |
38,964 |
$1.20M |
| G0390 |
Trauma respons w/hosp criti |
481 |
448 |
$1.18M |
| J7307 |
Etonogestrel implant system |
989 |
930 |
$1.17M |
| 0760 |
|
31,889 |
25,284 |
$881K |
| 76818 |
|
13,426 |
6,632 |
$796K |
| 99392 |
|
11,762 |
11,603 |
$668K |
| J9271 |
Inj pembrolizumab |
48 |
37 |
$661K |
| 0761 |
|
25,094 |
19,747 |
$577K |
| 99391 |
|
9,483 |
9,143 |
$531K |
| 74177 |
|
1,655 |
1,595 |
$459K |
| 90674 |
|
13,717 |
13,583 |
$429K |
| 96361 |
|
12,631 |
6,827 |
$424K |
| 90739 |
|
3,191 |
3,135 |
$421K |
| 87491 |
|
16,617 |
15,204 |
$409K |
| 87591 |
|
16,610 |
15,198 |
$407K |
| 99393 |
|
6,534 |
6,482 |
$403K |
| 90715 |
|
11,752 |
10,989 |
$396K |
| 96110 |
|
6,617 |
6,305 |
$385K |
| 90651 |
|
3,627 |
3,594 |
$376K |
| 99212 |
|
14,274 |
13,621 |
$366K |
| 96374 |
|
6,413 |
5,695 |
$359K |
| 99394 |
|
3,874 |
3,835 |
$291K |
| 0202U |
|
776 |
772 |
$289K |
| J3490 |
Drugs unclassified injection |
15,515 |
8,307 |
$270K |
| 88175 |
|
11,156 |
11,067 |
$257K |
| 80053 |
|
29,122 |
24,381 |
$244K |
| 96365 |
|
3,272 |
2,330 |
$241K |
| 85025 |
|
39,107 |
32,746 |
$232K |
| 0360 |
|
1,355 |
742 |
$229K |
| 99204 |
|
2,805 |
2,750 |
$224K |
| 96375 |
|
6,063 |
4,717 |
$224K |
| 96413 |
|
6,860 |
3,219 |
$221K |
| 82306 |
|
10,801 |
9,861 |
$220K |
| 90677 |
|
2,130 |
2,059 |
$213K |
| 90732 |
|
1,564 |
1,293 |
$207K |
| 70450 |
|
1,699 |
1,617 |
$207K |
| 99205 |
Prolong outpt/office vis |
1,537 |
1,506 |
$202K |
| 80307 |
|
4,107 |
3,247 |
$193K |
| 90686 |
|
13,073 |
10,243 |
$190K |
| 90791 |
|
1,211 |
1,179 |
$185K |
| 76811 |
|
2,120 |
1,966 |
$177K |
| 87624 |
|
8,676 |
8,568 |
$171K |
| 90670 |
|
10,998 |
10,629 |
$168K |
| 84443 |
|
13,481 |
12,154 |
$164K |
| 96127 |
|
23,575 |
22,798 |
$160K |
| 93005 |
|
7,987 |
7,287 |
$157K |
| 96372 |
|
6,882 |
6,250 |
$155K |
| 99203 |
|
2,277 |
2,220 |
$152K |
| 96360 |
|
2,464 |
1,849 |
$141K |
| U0002 |
Covid-19 lab test non-cdc |
2,866 |
2,762 |
$141K |
| 71046 |
|
8,036 |
7,551 |
$137K |
| 86480 |
|
4,064 |
3,768 |
$130K |
| 71260 |
|
598 |
569 |
$127K |
| 72125 |
|
637 |
604 |
$119K |
| 92551 |
|
11,184 |
11,093 |
$116K |
| 80061 |
|
12,150 |
11,278 |
$116K |
| 90837 |
|
1,379 |
987 |
$113K |
| 83036 |
|
15,688 |
14,374 |
$110K |
| 59430 |
|
1,395 |
1,350 |
$109K |
| 96415 |
|
2,147 |
1,246 |
$103K |
| 0510 |
|
4,510 |
4,131 |
$99K |
| 99173 |
|
21,848 |
21,440 |
$99K |
| 86331 |
|
6,465 |
5,876 |
$97K |
| U0003 |
Cov-19 amp prb hgh thruput |
1,062 |
1,026 |
$96K |
| Z7610 |
|
13,668 |
8,949 |
$96K |
| 99606 |
|
4,195 |
3,887 |
$94K |
| 88305 |
|
4,178 |
3,837 |
$92K |
| 99215 |
Prolong outpt/office vis |
2,445 |
2,352 |
$88K |
| 0270 |
|
10,569 |
6,146 |
$88K |
| 86171 |
|
6,449 |
5,860 |
$86K |
| 0002A |
|
1,998 |
1,998 |
$78K |
| 93306 |
|
689 |
672 |
$78K |
| 99381 |
|
1,262 |
1,233 |
$76K |
| 80048 |
|
11,635 |
9,968 |
$76K |
| 96417 |
|
1,947 |
963 |
$72K |
| J7030 |
Normal saline solution infus |
7,156 |
4,488 |
$71K |
| 87389 |
|
4,552 |
4,183 |
$71K |
| 90680 |
|
7,462 |
7,147 |
$69K |
| 81002 |
|
28,606 |
19,421 |
$69K |
| 99385 |
|
517 |
504 |
$66K |
| 90832 |
|
1,514 |
1,292 |
$65K |
| 0001A |
|
1,764 |
1,764 |
$64K |
| 99284 |
|
1,158 |
1,145 |
$63K |
| 71045 |
|
3,961 |
3,632 |
$62K |
| 84439 |
|
9,110 |
8,129 |
$60K |
| 80074 |
|
1,711 |
1,523 |
$60K |
| 90633 |
|
6,458 |
6,348 |
$60K |
| 76805 |
|
941 |
911 |
$57K |
| J0561 |
Penicillin g benzathine inj |
139 |
81 |
$56K |
| 90647 |
|
5,884 |
5,643 |
$54K |
| 90710 |
|
5,768 |
5,688 |
$54K |
| 81001 |
|
19,091 |
17,150 |
$53K |
| 99283 |
|
552 |
530 |
$52K |
| 73130 |
|
2,591 |
1,630 |
$51K |
| 87086 |
|
8,681 |
7,587 |
$51K |
| 81025 |
|
13,637 |
12,963 |
$51K |
| 90750 |
|
269 |
264 |
$50K |
| 99607 |
|
2,273 |
2,125 |
$50K |
| 90723 |
|
5,236 |
4,923 |
$48K |
| 72100 |
|
2,196 |
2,018 |
$47K |
| J1642 |
Inj heparin sodium per 10 u |
6,150 |
3,537 |
$46K |
| 96366 |
|
1,244 |
873 |
$46K |
| 83735 |
|
8,896 |
5,712 |
$46K |
| 0710 |
|
1,328 |
1,212 |
$45K |
| 90697 |
|
4,647 |
4,590 |
$42K |
| 99396 |
|
343 |
337 |
$42K |
| 96156 |
|
487 |
487 |
$41K |
| 99188 |
|
1,773 |
1,755 |
$38K |
| 90734 |
|
3,717 |
3,697 |
$37K |
| 99395 |
|
303 |
282 |
$36K |
| J7298 |
Mirena, 52 mg |
27 |
27 |
$35K |
| 73030 |
|
1,816 |
1,477 |
$35K |
| 73110 |
|
2,000 |
1,251 |
$34K |
| 86780 |
|
3,967 |
3,385 |
$34K |
| 96523 |
|
1,270 |
1,197 |
$33K |
| 80076 |
|
5,867 |
5,176 |
$33K |
| 76705 |
|
576 |
570 |
$31K |
| 73562 |
|
1,590 |
1,313 |
$30K |
| 84100 |
|
8,188 |
5,430 |
$29K |
| 73630 |
|
1,673 |
1,219 |
$29K |
| 76815 |
|
722 |
412 |
$29K |
| 90746 |
|
328 |
320 |
$29K |
| 77067 |
|
314 |
312 |
$28K |
| Q0166 |
Granisetron hcl 1 mg oral |
3,870 |
1,584 |
$28K |
| 73610 |
|
1,458 |
1,091 |
$26K |
| 99199 |
|
466 |
410 |
$25K |
| 90649 |
|
2,461 |
2,449 |
$25K |
| J1885 |
Ketorolac tromethamine inj |
4,471 |
4,088 |
$25K |
| 82607 |
|
2,339 |
2,099 |
$24K |
| 99383 |
|
270 |
266 |
$23K |
| 0250 |
|
1,194 |
659 |
$23K |
| 90700 |
|
2,541 |
2,505 |
$23K |
| 90834 |
|
273 |
230 |
$23K |
| 83690 |
|
4,147 |
3,871 |
$23K |
| 87081 |
|
4,844 |
4,378 |
$22K |
| 90696 |
|
2,400 |
2,388 |
$22K |
| 85730 |
|
4,730 |
4,355 |
$22K |
| 59025 |
|
1,307 |
840 |
$22K |
| 92552 |
|
1,705 |
1,695 |
$22K |
| 0514 |
|
915 |
829 |
$21K |
| 82043 |
|
5,172 |
4,675 |
$21K |
| 82570 |
|
5,607 |
5,028 |
$21K |
| 80050 |
|
237 |
237 |
$20K |
| 76856 |
|
332 |
328 |
$20K |
| 73560 |
|
1,417 |
865 |
$20K |
| 92228 |
|
1,286 |
1,282 |
$19K |
| 99244 |
|
233 |
233 |
$19K |
| 99211 |
|
1,737 |
1,702 |
$19K |
| 86235 |
|
1,420 |
1,156 |
$19K |
| 43239 |
|
64 |
59 |
$19K |
| 99282 |
|
826 |
813 |
$19K |
| G0480 |
Drug test def 1-7 classes |
400 |
293 |
$19K |
| 85027 |
|
3,942 |
3,308 |
$19K |
| 86140 |
|
4,843 |
4,237 |
$18K |
| 85610 |
|
5,863 |
5,087 |
$18K |
| 90620 |
|
1,876 |
1,865 |
$18K |
| J2270 |
Morphine sulfate injection |
2,545 |
2,073 |
$18K |
| 87186 |
|
2,928 |
2,527 |
$18K |
| 99243 |
|
345 |
344 |
$18K |
| J7040 |
Normal saline solution infus |
2,745 |
1,356 |
$18K |
| 0004A |
|
442 |
442 |
$18K |
| J2315 |
Naltrexone, depot form |
27 |
27 |
$17K |
| 83520 |
|
1,728 |
1,452 |
$17K |
| 90471 |
|
9,949 |
9,866 |
$17K |
| 86803 |
|
1,572 |
1,503 |
$16K |
| 82378 |
|
1,159 |
817 |
$16K |
| 93010 |
|
1,760 |
1,585 |
$15K |
| 87340 |
|
1,941 |
1,725 |
$15K |
| 90662 |
|
224 |
168 |
$15K |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
1,385 |
1,363 |
$15K |
| 82728 |
|
1,518 |
1,323 |
$14K |
| J3010 |
Fentanyl citrate injection |
2,440 |
2,193 |
$14K |
| J2405 |
Ondansetron hcl injection |
2,874 |
2,580 |
$14K |
| 72040 |
|
777 |
689 |
$14K |
| 99070 |
|
26,563 |
11,207 |
$14K |
| 86850 |
|
3,259 |
2,914 |
$14K |
| J1100 |
Dexamethasone sodium phos |
1,736 |
1,292 |
$13K |
| 83655 |
|
1,728 |
1,610 |
$13K |
| 84702 |
|
1,216 |
930 |
$13K |
| 96367 |
|
303 |
181 |
$12K |
| J1200 |
Diphenhydramine hcl injectio |
2,660 |
1,889 |
$12K |
| 88720 |
|
2,649 |
2,215 |
$12K |
| 84484 |
|
1,493 |
1,336 |
$12K |
| 86255 |
|
1,344 |
1,095 |
$12K |
| 86901 |
|
3,743 |
3,336 |
$12K |
| J7050 |
Normal saline solution infus |
2,111 |
1,285 |
$12K |
| 86762 |
|
999 |
897 |
$12K |
| 87077 |
|
1,955 |
1,810 |
$11K |
| 85652 |
|
5,520 |
4,765 |
$11K |
| G0444 |
Depression screen annual |
643 |
588 |
$11K |
| 96376 |
|
244 |
211 |
$11K |
| 83880 |
|
473 |
439 |
$11K |
| 86038 |
|
3,290 |
2,808 |
$10K |
| 76830 |
|
190 |
185 |
$10K |
| 82948 |
|
2,900 |
2,477 |
$10K |
| 0054A |
|
256 |
256 |
$10K |
| 11981 |
|
415 |
402 |
$10K |
| 58100 |
|
350 |
347 |
$9K |
| 88307 |
|
200 |
200 |
$9K |
| 99384 |
|
93 |
90 |
$9K |
| J0690 |
Cefazolin sodium injection |
646 |
596 |
$9K |
| J0696 |
Ceftriaxone sodium injection |
1,362 |
1,184 |
$9K |
| 85018 |
|
7,258 |
6,895 |
$9K |
| 76770 |
|
128 |
126 |
$8K |
| 86160 |
|
770 |
604 |
$8K |
| 74018 |
|
482 |
442 |
$8K |
| 99202 |
|
228 |
227 |
$8K |
| 81003 |
|
3,954 |
3,590 |
$8K |
| 86900 |
|
2,635 |
2,473 |
$8K |
| J2250 |
Inj midazolam hydrochloride |
1,365 |
1,241 |
$7K |
| 83970 |
|
253 |
237 |
$7K |
| 83540 |
|
1,508 |
1,328 |
$7K |
| J2001 |
Lidocaine injection |
1,363 |
1,193 |
$7K |
| 84153 |
|
713 |
660 |
$7K |
| J3301 |
Triamcinolone acet inj nos |
479 |
432 |
$7K |
| 87070 |
|
989 |
935 |
$7K |
| 83550 |
|
1,166 |
1,039 |
$7K |
| Q0162 |
Ondansetron oral |
211 |
206 |
$6K |
| 87635 |
|
112 |
106 |
$6K |
| 84703 |
|
1,171 |
1,019 |
$6K |
| 0072A |
|
153 |
153 |
$6K |
| 87210 |
|
1,954 |
1,910 |
$6K |
| 97802 |
|
229 |
200 |
$6K |
| 86431 |
|
1,451 |
1,221 |
$6K |
| 90678 |
|
54 |
54 |
$6K |
| 83605 |
|
665 |
602 |
$6K |
| 0052A |
|
143 |
143 |
$6K |
| 94640 |
|
278 |
254 |
$5K |
| 72170 |
|
286 |
233 |
$5K |
| 90672 |
|
590 |
590 |
$5K |
| 0071A |
|
129 |
129 |
$5K |
| J1170 |
Hydromorphone injection |
537 |
427 |
$5K |
| 73120 |
|
393 |
220 |
$5K |
| 90656 |
|
536 |
522 |
$5K |
| 86317 |
|
924 |
921 |
$5K |
| 82950 |
|
1,285 |
1,068 |
$5K |
| 90694 |
|
61 |
61 |
$5K |
| 86162 |
|
640 |
501 |
$5K |
| J2704 |
Inj, propofol, 10 mg |
831 |
772 |
$4K |
| J1050 |
Medroxyprogesterone acetate |
298 |
270 |
$4K |
| 11982 |
|
188 |
186 |
$4K |
| 73590 |
|
184 |
152 |
$4K |
| 82247 |
|
940 |
736 |
$4K |
| J2765 |
Metoclopramide hcl injection |
804 |
759 |
$4K |
| 57454 |
|
129 |
128 |
$4K |
| 73090 |
|
149 |
125 |
$4K |
| 87804 |
|
468 |
290 |
$4K |
| 86704 |
|
673 |
633 |
$4K |
| 87088 |
|
814 |
587 |
$4K |
| G0442 |
Annual alcohol screen 15 min |
286 |
273 |
$4K |
| J9045 |
Carboplatin injection |
210 |
109 |
$4K |
| 87880 |
|
439 |
432 |
$4K |
| 84999 |
|
390 |
351 |
$4K |
| H2000 |
Comp multidisipln evaluation |
42 |
42 |
$4K |
| 72070 |
|
172 |
166 |
$4K |
| 99386 |
|
26 |
26 |
$4K |
| J9267 |
Paclitaxel injection |
282 |
110 |
$3K |
| 90480 |
|
86 |
86 |
$3K |
| 73502 |
|
129 |
113 |
$3K |
| 76536 |
|
62 |
61 |
$3K |
| 86592 |
|
1,412 |
1,350 |
$3K |
| 72202 |
|
140 |
113 |
$3K |
| J3420 |
Vitamin b12 injection |
690 |
472 |
$3K |
| 76819 |
|
75 |
16 |
$3K |
| 82785 |
|
244 |
184 |
$3K |
| 76641 |
|
43 |
40 |
$3K |
| G0500 |
Mod sedat endo service >5yrs |
59 |
58 |
$3K |
| 87338 |
|
274 |
241 |
$3K |
| 0320 |
|
86 |
81 |
$3K |
| 82550 |
|
520 |
423 |
$2K |
| 86146 |
|
121 |
92 |
$2K |
| 58300 |
|
137 |
137 |
$2K |
| J7120 |
Ringers lactate infusion |
407 |
382 |
$2K |
| 90792 |
|
15 |
13 |
$2K |
| 76700 |
|
39 |
39 |
$2K |
| 86021 |
|
153 |
120 |
$2K |
| 90707 |
|
191 |
189 |
$2K |
| 86376 |
|
266 |
195 |
$2K |
| 0051A |
|
54 |
54 |
$2K |
| 90472 |
|
3,277 |
3,262 |
$2K |
| P9011 |
Blood split unit |
745 |
567 |
$2K |
| 84550 |
|
682 |
586 |
$2K |
| 87522 |
Neg quan hep c or qual rna |
99 |
98 |
$2K |
| C9803 |
Hopd covid-19 spec collect |
93 |
89 |
$2K |
| 86706 |
|
475 |
407 |
$2K |
| 73080 |
|
99 |
89 |
$2K |
| G0108 |
Diab manage trn per indiv |
91 |
86 |
$2K |
| 86708 |
|
317 |
315 |
$2K |
| 90716 |
|
196 |
193 |
$2K |
| J7060 |
5% dextrose/water |
292 |
84 |
$2K |
| 92134 |
|
87 |
87 |
$2K |
| 92015 |
|
76 |
76 |
$2K |
| 83615 |
|
440 |
340 |
$2K |
| 90681 |
|
204 |
191 |
$2K |
| 86003 |
|
384 |
284 |
$2K |
| Z7506 |
|
12 |
12 |
$2K |
| 87536 |
|
27 |
26 |
$2K |
| 83525 |
|
260 |
260 |
$2K |
| 82105 |
|
164 |
155 |
$2K |
| 86147 |
|
120 |
91 |
$2K |
| 86300 |
|
176 |
133 |
$2K |
| 76642 |
|
30 |
30 |
$2K |
| 90380 |
|
193 |
178 |
$2K |
| 91320 |
|
12 |
12 |
$2K |
| 80299 |
|
124 |
110 |
$2K |
| 96368 |
|
79 |
48 |
$1K |
| 99605 |
|
58 |
58 |
$1K |
| 84480 |
|
289 |
266 |
$1K |
| 87205 |
|
500 |
395 |
$1K |
| A4217 |
Sterile water/saline, 500 ml |
208 |
186 |
$1K |
| 73100 |
|
102 |
55 |
$1K |
| 0517 |
|
51 |
43 |
$1K |
| 74176 |
|
35 |
35 |
$1K |
| 45378 |
|
14 |
12 |
$1K |
| 69209 |
|
81 |
80 |
$1K |
| H1001 |
Antepartum management |
41 |
34 |
$1K |
| 0515 |
|
52 |
47 |
$1K |
| 12001 |
|
53 |
53 |
$1K |
| 58301 |
|
49 |
48 |
$1K |
| 82248 |
|
399 |
296 |
$1K |
| 83001 |
|
82 |
72 |
$1K |
| 86812 |
|
84 |
55 |
$1K |
| 90381 |
|
137 |
121 |
$1K |
| 71020 |
|
39 |
26 |
$1K |
| 0124A |
|
26 |
26 |
$1K |
| 85613 |
|
116 |
89 |
$970.01 |
| 93971 |
|
28 |
25 |
$953.21 |
| 82746 |
|
88 |
76 |
$952.66 |
| 76817 |
|
29 |
26 |
$946.52 |
| 82270 |
|
372 |
338 |
$894.12 |
| 76801 |
|
40 |
38 |
$892.20 |
| 90660 |
|
98 |
98 |
$882.00 |
| 97803 |
|
167 |
167 |
$846.51 |
| 82951 |
|
93 |
88 |
$835.10 |
| 99401 |
|
45 |
45 |
$794.25 |
| 72072 |
|
34 |
28 |
$770.71 |
| 84403 |
|
134 |
111 |
$765.00 |
| 99153 |
Mod sedat endo service >5yrs |
63 |
60 |
$763.23 |
| Z7512 |
|
25 |
24 |
$653.25 |
| 86360 |
|
26 |
25 |
$650.00 |
| 99382 |
|
12 |
12 |
$648.01 |
| 86039 |
|
102 |
98 |
$644.36 |
| 82274 |
|
55 |
55 |
$640.74 |
| 82784 |
|
110 |
91 |
$635.52 |
| 72046 |
|
33 |
33 |
$628.65 |
| 12011 |
|
18 |
18 |
$612.02 |
| 0064A |
|
15 |
15 |
$600.00 |
| 99241 |
|
15 |
15 |
$589.54 |
| 99281 |
|
13 |
12 |
$555.76 |
| H1003 |
Prenatal at risk education |
68 |
67 |
$551.64 |
| 90685 |
|
305 |
303 |
$527.31 |
| 83002 |
|
39 |
39 |
$525.42 |
| 82150 |
|
110 |
101 |
$507.12 |
| 84154 |
|
169 |
166 |
$482.69 |
| 96150 |
|
59 |
57 |
$470.56 |
| Z6400 |
|
39 |
39 |
$470.34 |
| 90648 |
|
52 |
48 |
$468.00 |
| 86705 |
|
52 |
52 |
$454.39 |
| J2060 |
Lorazepam injection |
113 |
104 |
$452.11 |
| 84146 |
|
31 |
27 |
$439.55 |
| 10060 |
|
45 |
41 |
$426.05 |
| 96411 |
|
32 |
12 |
$401.46 |
| 86200 |
|
60 |
60 |
$399.17 |
| 99233 |
Prolong inpt eval add15 m |
66 |
24 |
$386.41 |
| 12002 |
|
12 |
12 |
$371.97 |
| 76870 |
|
13 |
12 |
$365.76 |
| G8510 |
Scr dep neg, no plan reqd |
27 |
27 |
$361.26 |
| 84481 |
|
69 |
66 |
$347.76 |
| 99201 |
|
14 |
14 |
$333.72 |
| J2274 |
Inj morphine pf epid ithc |
167 |
147 |
$319.16 |
| 82977 |
|
138 |
111 |
$311.18 |
| 83516 |
|
38 |
24 |
$293.64 |
| 86580 |
|
63 |
60 |
$292.63 |
| 86695 |
|
38 |
25 |
$288.22 |
| 86696 |
|
38 |
25 |
$288.22 |
| V5008 |
Hearing screening |
13 |
13 |
$285.54 |
| 87625 |
|
14 |
14 |
$285.02 |
| 17110 |
|
13 |
12 |
$281.60 |
| 88142 |
|
84 |
84 |
$277.32 |
| J7611 |
Albuterol non-comp con |
377 |
332 |
$268.16 |
| 86304 |
|
34 |
27 |
$264.00 |
| 90713 |
|
28 |
28 |
$252.00 |
| 84156 |
|
101 |
89 |
$231.79 |
| 86800 |
|
46 |
42 |
$225.31 |
| 82952 |
|
76 |
72 |
$210.22 |
| 81000 |
|
181 |
178 |
$204.07 |
| 11983 |
|
12 |
12 |
$201.60 |
| 99001 |
|
150 |
146 |
$200.07 |
| 73000 |
|
12 |
12 |
$189.68 |
| 29125 |
|
13 |
13 |
$189.60 |
| 86403 |
|
18 |
18 |
$184.60 |
| 86671 |
|
13 |
12 |
$174.09 |
| 87902 |
|
13 |
13 |
$160.00 |
| J2175 |
Meperidine hydrochl /100 mg |
15 |
12 |
$159.85 |
| 88304 |
|
13 |
12 |
$159.84 |
| 84436 |
|
35 |
29 |
$154.00 |
| 90473 |
|
526 |
526 |
$153.00 |
| J8540 |
Oral dexamethasone |
23 |
12 |
$137.33 |
| J7620 |
Albuterol ipratrop non-comp |
51 |
44 |
$120.78 |
| 90744 |
|
13 |
13 |
$117.00 |
| 84402 |
|
17 |
13 |
$102.00 |
| 84165 |
|
19 |
12 |
$98.56 |
| 82272 |
|
59 |
58 |
$88.06 |
| 80143 |
|
12 |
12 |
$86.78 |
| 85014 |
|
41 |
39 |
$85.35 |
| 87040 |
|
16 |
14 |
$76.42 |
| 94060 |
|
12 |
12 |
$62.02 |
| 82010 |
|
13 |
12 |
$54.61 |
| 88312 |
|
13 |
13 |
$52.52 |
| J0780 |
Prochlorperazine injection |
15 |
14 |
$47.26 |
| 82565 |
|
13 |
12 |
$40.86 |
| 87147 |
|
12 |
12 |
$28.82 |
| 3079F |
|
3,466 |
3,294 |
$0.00 |
| 3074F |
|
6,026 |
5,623 |
$0.00 |
| 3075F |
|
1,302 |
1,236 |
$0.00 |
| 0370 |
|
20 |
12 |
$0.00 |
| 90673 |
|
124 |
122 |
$0.00 |
| 3080F |
|
30 |
29 |
$0.00 |
| 2023F |
|
27 |
27 |
$0.00 |
| G9008 |
Mccd,phys coor-care ovrsght |
27 |
27 |
$0.00 |
| 36415 |
|
13 |
13 |
$0.00 |
| 3078F |
|
5,476 |
5,075 |
$0.00 |
| H1002 |
Carecoordination prenatal |
37 |
37 |
$0.00 |
| 3077F |
|
797 |
738 |
$0.00 |
| 80361 |
|
555 |
373 |
$0.00 |
| J1750 |
Inj iron dextran |
26 |
26 |
$0.00 |
| 92133 |
|
13 |
13 |
$0.00 |
| 90661 |
|
12 |
12 |
$0.00 |