| Code | Description | Claims | Beneficiaries | Total Paid |
| 0241U |
|
9,220 |
8,745 |
$1.18M |
| L3000 |
Ft insert ucb berkeley shell |
1,823 |
1,428 |
$615K |
| 76700 |
|
1,905 |
1,904 |
$206K |
| 77067 |
|
950 |
950 |
$161K |
| 87502 |
|
1,939 |
1,924 |
$150K |
| 80307 |
|
1,834 |
1,794 |
$119K |
| 82306 |
|
5,445 |
5,398 |
$119K |
| 84443 |
|
8,718 |
8,580 |
$118K |
| 80061 |
|
9,103 |
9,019 |
$96K |
| 99211 |
|
4,937 |
4,229 |
$90K |
| 86769 |
|
1,361 |
1,334 |
$88K |
| 87651 |
|
2,764 |
2,731 |
$87K |
| 80053 |
|
9,492 |
9,369 |
$81K |
| 99214 |
|
1,753 |
1,564 |
$70K |
| 85025 |
|
10,355 |
10,206 |
$64K |
| 99213 |
|
5,811 |
5,382 |
$57K |
| 99223 |
Prolong inpt eval add15 m |
504 |
468 |
$54K |
| 83036 |
|
6,369 |
6,291 |
$52K |
| 71046 |
|
1,602 |
1,585 |
$52K |
| 84439 |
|
6,392 |
6,324 |
$46K |
| 0012A |
|
1,101 |
1,101 |
$39K |
| 73562 |
|
1,129 |
1,047 |
$38K |
| 0011A |
|
1,086 |
1,086 |
$35K |
| 76536 |
|
333 |
330 |
$33K |
| 87426 |
|
890 |
881 |
$32K |
| 0001A |
|
708 |
708 |
$27K |
| 72100 |
|
833 |
832 |
$26K |
| 82746 |
|
2,128 |
2,118 |
$26K |
| 90715 |
|
592 |
591 |
$25K |
| 73630 |
|
856 |
801 |
$25K |
| 99222 |
|
235 |
230 |
$24K |
| 0002A |
|
598 |
598 |
$24K |
| 11721 |
|
3,978 |
3,700 |
$21K |
| 86480 |
|
458 |
452 |
$20K |
| 93303 |
|
101 |
101 |
$19K |
| 76770 |
|
194 |
194 |
$18K |
| 82607 |
|
1,516 |
1,503 |
$18K |
| 99460 |
|
192 |
188 |
$17K |
| 87491 |
|
660 |
643 |
$17K |
| 99232 |
|
356 |
264 |
$17K |
| 76856 |
|
156 |
156 |
$16K |
| 43239 |
|
139 |
139 |
$16K |
| 86481 |
|
253 |
251 |
$16K |
| 76641 |
|
117 |
108 |
$14K |
| 84480 |
|
1,191 |
1,179 |
$13K |
| 73030 |
|
512 |
494 |
$13K |
| 72110 |
|
300 |
299 |
$12K |
| A5500 |
Diab shoe for density insert |
209 |
154 |
$12K |
| 99490 |
Ccm add 20min |
3,911 |
3,909 |
$11K |
| 87591 |
|
398 |
388 |
$10K |
| 99309 |
|
1,184 |
1,043 |
$10K |
| J3420 |
Vitamin b12 injection |
2,202 |
2,051 |
$9K |
| 11056 |
|
927 |
764 |
$8K |
| A5512 |
Multi den insert direct form |
176 |
166 |
$8K |
| 99203 |
|
181 |
181 |
$8K |
| 45378 |
|
45 |
45 |
$8K |
| 93306 |
|
39 |
39 |
$7K |
| 99308 |
|
1,714 |
1,507 |
$7K |
| 99462 |
|
175 |
120 |
$7K |
| 83550 |
|
956 |
950 |
$6K |
| 83540 |
|
1,149 |
1,141 |
$6K |
| 72040 |
|
200 |
198 |
$6K |
| 73610 |
|
162 |
155 |
$5K |
| 81002 |
|
2,932 |
2,828 |
$5K |
| 90686 |
|
179 |
179 |
$5K |
| 99454 |
|
710 |
699 |
$4K |
| J1885 |
Ketorolac tromethamine inj |
772 |
700 |
$4K |
| 81025 |
|
1,266 |
1,220 |
$4K |
| 74018 |
|
102 |
102 |
$4K |
| 87804 |
|
206 |
200 |
$4K |
| 99238 |
|
55 |
55 |
$3K |
| 0013A |
|
78 |
78 |
$3K |
| J3301 |
Triamcinolone acet inj nos |
431 |
374 |
$3K |
| 84153 |
|
175 |
172 |
$3K |
| 99239 |
|
25 |
25 |
$2K |
| 80305 |
|
242 |
239 |
$2K |
| 95004 |
|
88 |
88 |
$2K |
| 20611 |
|
52 |
26 |
$2K |
| 82977 |
|
429 |
424 |
$2K |
| 87635 |
|
44 |
42 |
$2K |
| 95144 |
|
79 |
16 |
$2K |
| 99306 |
Prolong nursin fac eval 15m |
469 |
434 |
$2K |
| 82728 |
|
185 |
184 |
$2K |
| 77065 |
Tomosynthesis, mammo |
12 |
12 |
$2K |
| 99215 |
Prolong outpt/office vis |
12 |
12 |
$2K |
| 73130 |
|
57 |
51 |
$2K |
| 80076 |
|
279 |
278 |
$2K |
| 86140 |
|
395 |
391 |
$2K |
| 99000 |
|
438 |
430 |
$2K |
| 92250 |
|
67 |
67 |
$2K |
| 76830 |
|
16 |
16 |
$2K |
| 69209 |
|
187 |
118 |
$1K |
| 76642 |
|
14 |
14 |
$1K |
| 76705 |
|
15 |
15 |
$1K |
| 86235 |
|
14 |
14 |
$1K |
| 90673 |
|
14 |
14 |
$1K |
| 87880 |
|
129 |
129 |
$1K |
| 99204 |
|
41 |
41 |
$1K |
| 90682 |
|
13 |
13 |
$1K |
| 86580 |
|
283 |
270 |
$963.83 |
| 72050 |
|
25 |
25 |
$917.32 |
| 82962 |
|
415 |
405 |
$838.44 |
| 83735 |
|
159 |
159 |
$830.07 |
| A6219 |
Gauze <= 16 sq in w/border |
64 |
52 |
$682.40 |
| 90656 |
|
24 |
24 |
$643.44 |
| 82044 |
|
157 |
157 |
$598.46 |
| 0031A |
|
20 |
20 |
$591.29 |
| 77085 |
|
13 |
13 |
$564.80 |
| 73110 |
|
14 |
14 |
$533.04 |
| 99457 |
|
229 |
227 |
$518.16 |
| A6266 |
Impreg gauze no h20/sal/yard |
57 |
37 |
$517.05 |
| 99212 |
|
47 |
45 |
$456.56 |
| 84550 |
|
179 |
179 |
$448.13 |
| A4217 |
Sterile water/saline, 500 ml |
65 |
53 |
$414.00 |
| 85652 |
|
190 |
189 |
$405.57 |
| 93922 |
|
12 |
12 |
$353.28 |
| 96372 |
|
493 |
460 |
$342.30 |
| 90648 |
|
26 |
26 |
$234.00 |
| 90670 |
|
26 |
26 |
$234.00 |
| 90723 |
|
21 |
21 |
$189.00 |
| 99335 |
|
872 |
455 |
$157.27 |
| J1071 |
Inj testosterone cypionate |
35 |
25 |
$148.94 |
| 86225 |
|
14 |
14 |
$146.91 |
| 90680 |
|
16 |
16 |
$144.00 |
| 99458 |
|
103 |
103 |
$137.19 |
| A6453 |
Self-adher band w <3"/yd |
63 |
52 |
$134.21 |
| 86226 |
|
14 |
14 |
$129.54 |
| 83516 |
|
15 |
14 |
$118.99 |
| 99453 |
|
40 |
39 |
$117.60 |
| 85018 |
|
46 |
45 |
$101.98 |
| 86200 |
|
14 |
14 |
$85.42 |
| 86430 |
|
14 |
14 |
$60.64 |
| 86431 |
|
14 |
14 |
$60.44 |
| 36415 |
|
99 |
97 |
$46.21 |
| 99173 |
|
13 |
13 |
$40.56 |
| 90688 |
|
16 |
16 |
$31.22 |
| 82150 |
|
13 |
13 |
$16.36 |
| 84450 |
|
19 |
19 |
$12.60 |
| 82947 |
|
18 |
18 |
$10.11 |
| 99318 |
|
13 |
13 |
$9.94 |
| 84460 |
|
18 |
18 |
$9.34 |
| 82565 |
|
18 |
18 |
$8.80 |
| 84075 |
|
18 |
18 |
$8.42 |
| 82310 |
|
18 |
18 |
$8.36 |
| 82247 |
|
18 |
18 |
$8.34 |
| 82040 |
|
18 |
18 |
$8.20 |
| 84520 |
|
18 |
18 |
$6.42 |
| 84155 |
|
18 |
18 |
$6.04 |
| 3078F |
|
15 |
13 |
$0.00 |
| G0008 |
Admin influenza virus vac |
23 |
23 |
$0.00 |
| 99327 |
|
13 |
13 |
$0.00 |
| 3074F |
|
14 |
14 |
$0.00 |