| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 96361 |
|
402 |
359 |
$55K |
| 97110 |
|
1,149 |
334 |
$49K |
| 99284 |
|
924 |
846 |
$45K |
| 99283 |
|
838 |
792 |
$44K |
| 99285 |
|
414 |
380 |
$22K |
| 80053 |
|
652 |
605 |
$17K |
| 97140 |
|
690 |
229 |
$17K |
| 87502 |
|
168 |
159 |
$17K |
| 43239 |
|
85 |
81 |
$16K |
| 99282 |
|
186 |
174 |
$13K |
| 87081 |
|
207 |
201 |
$10K |
| 45380 |
|
69 |
60 |
$9K |
| 96360 |
|
101 |
98 |
$9K |
| 96365 |
|
128 |
101 |
$7K |
| 94640 |
|
132 |
121 |
$7K |
| 85025 |
|
935 |
838 |
$7K |
| 80048 |
|
380 |
337 |
$7K |
| 74177 |
|
87 |
81 |
$7K |
| 70450 |
|
142 |
134 |
$6K |
| 81001 |
|
461 |
425 |
$6K |
| G0480 |
Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 1-7 drug class(es), including metabolite(s) if performed |
90 |
84 |
$5K |
| 87880 |
|
230 |
224 |
$5K |
| 81025 |
|
368 |
344 |
$4K |
| 80307 |
|
69 |
67 |
$4K |
| 77067 |
|
116 |
110 |
$4K |
| 82962 |
|
206 |
175 |
$4K |
| 99281 |
|
38 |
38 |
$4K |
| 71046 |
|
412 |
380 |
$3K |
| 97161 |
|
67 |
65 |
$3K |
| 81003 |
|
277 |
261 |
$3K |
| 84484 |
|
276 |
224 |
$2K |
| 45385 |
|
15 |
13 |
$2K |
| 87491 |
|
52 |
52 |
$2K |
| 87591 |
|
52 |
52 |
$2K |
| 83690 |
|
245 |
222 |
$2K |
| 97162 |
|
43 |
39 |
$2K |
| 97530 |
|
65 |
38 |
$2K |
| 82565 |
|
47 |
42 |
$1K |
| 76830 |
|
16 |
16 |
$1K |
| 85610 |
|
148 |
140 |
$1K |
| 87086 |
|
132 |
118 |
$915.47 |
| 84443 |
|
55 |
54 |
$906.45 |
| 97112 |
|
33 |
12 |
$883.25 |
| 74176 |
|
14 |
14 |
$718.48 |
| 82550 |
|
60 |
55 |
$667.66 |
| 83605 |
|
76 |
68 |
$605.75 |
| 85027 |
|
81 |
74 |
$546.24 |
| 93005 |
|
453 |
416 |
$501.20 |
| 76856 |
|
15 |
15 |
$494.46 |
| 80061 |
|
32 |
29 |
$476.14 |
| 74018 |
|
26 |
24 |
$402.79 |
| 80076 |
|
39 |
39 |
$341.25 |
| 85730 |
|
52 |
49 |
$282.34 |
| 71045 |
|
185 |
171 |
$261.82 |
| 83880 |
|
14 |
13 |
$238.88 |
| 85379 |
|
28 |
26 |
$236.40 |
| 82553 |
|
38 |
35 |
$190.95 |
| 87040 |
|
12 |
12 |
$171.52 |
| 87186 |
|
27 |
25 |
$167.98 |
| 83036 |
|
18 |
15 |
$162.54 |
| 86901 |
|
44 |
42 |
$142.28 |
| 77063 |
|
17 |
16 |
$126.75 |
| 96374 |
|
451 |
409 |
$120.77 |
| 73630 |
|
29 |
27 |
$107.55 |
| 72100 |
|
12 |
12 |
$83.90 |
| 86900 |
|
15 |
13 |
$77.23 |
| 86850 |
|
13 |
12 |
$64.83 |
| 73610 |
|
27 |
26 |
$64.80 |
| 83735 |
|
14 |
12 |
$64.15 |
| 73564 |
|
13 |
13 |
$48.80 |
| 73502 |
|
12 |
12 |
$32.00 |
| 96375 |
|
330 |
292 |
$28.23 |
| 88305 |
|
196 |
173 |
$9.83 |
| 36415 |
|
114 |
104 |
$3.00 |
| J2704 |
Injection, propofol, 10 mg |
189 |
164 |
$2.37 |
| 96372 |
|
186 |
163 |
$2.17 |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
336 |
302 |
$0.59 |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
224 |
203 |
$0.26 |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
271 |
247 |
$0.00 |
| J2270 |
Injection, morphine sulfate, up to 10 mg |
49 |
47 |
$0.00 |
| J1170 |
Injection, hydromorphone, up to 4 mg |
100 |
84 |
$0.00 |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
126 |
119 |
$0.00 |
| 96376 |
|
13 |
12 |
$0.00 |
| J0690 |
Injection, cefazolin sodium, 500 mg |
57 |
34 |
$0.00 |
| 94760 |
|
170 |
153 |
$0.00 |
| J2765 |
Injection, metoclopramide hcl, up to 10 mg |
71 |
68 |
$0.00 |
| J0131 |
Injection, acetaminophen, not otherwise specified,10 mg |
17 |
12 |
$0.00 |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
49 |
42 |
$0.00 |