| Code | Description | Claims | Beneficiaries | Total Paid |
| A9150 |
Misc/exper non-prescript dru |
60,638 |
27,244 |
$14.42M |
| 0450 |
|
55,270 |
49,961 |
$14.08M |
| 36415 |
|
65,736 |
57,268 |
$7.81M |
| 99284 |
|
39,866 |
37,308 |
$7.13M |
| 99283 |
|
48,625 |
45,705 |
$7.10M |
| T1999 |
Noc retail items andsupplies |
21,895 |
12,618 |
$5.89M |
| 99285 |
|
17,138 |
16,128 |
$4.64M |
| 99282 |
|
9,377 |
8,998 |
$1.86M |
| 80053 |
|
68,699 |
63,958 |
$1.42M |
| 0360 |
|
2,941 |
2,663 |
$1.39M |
| G0378 |
Hospital observation per hr |
790 |
713 |
$852K |
| 74177 |
|
6,095 |
5,957 |
$773K |
| 70450 |
|
8,381 |
8,169 |
$728K |
| U0003 |
Cov-19 amp prb hgh thruput |
5,111 |
4,868 |
$671K |
| 71046 |
|
15,414 |
14,870 |
$589K |
| 99499 |
|
1,758 |
1,081 |
$575K |
| 96372 |
|
22,121 |
20,035 |
$575K |
| Z7502 |
|
13,832 |
13,716 |
$514K |
| 0270 |
|
50,921 |
23,604 |
$508K |
| J3490 |
Drugs unclassified injection |
71,104 |
35,933 |
$495K |
| 99281 |
|
2,390 |
2,256 |
$432K |
| 71045 |
|
17,849 |
17,124 |
$428K |
| J7512 |
Prednisone ir or dr oral 1mg |
1,703 |
1,609 |
$394K |
| 66984 |
|
918 |
887 |
$381K |
| 0710 |
|
3,379 |
3,301 |
$363K |
| 85025 |
|
72,411 |
65,585 |
$346K |
| 96374 |
|
14,238 |
13,328 |
$343K |
| 0250 |
|
3,716 |
1,936 |
$339K |
| 74176 |
|
3,958 |
3,878 |
$336K |
| 0241U |
|
10,174 |
9,949 |
$329K |
| 0762 |
|
89 |
86 |
$324K |
| 93005 |
|
29,952 |
28,043 |
$322K |
| 43239 |
|
510 |
393 |
$320K |
| G0480 |
Drug test def 1-7 classes |
8,769 |
8,050 |
$315K |
| 99199 |
|
3,365 |
2,183 |
$262K |
| 0750 |
|
1,106 |
798 |
$258K |
| U0002 |
Covid-19 lab test non-cdc |
1,015 |
977 |
$254K |
| 96375 |
|
10,865 |
9,808 |
$249K |
| 80048 |
|
16,520 |
14,908 |
$220K |
| 88305 |
|
2,219 |
1,823 |
$218K |
| 59025 |
|
6,895 |
2,834 |
$209K |
| 45378 |
|
291 |
287 |
$202K |
| 72125 |
|
1,884 |
1,851 |
$197K |
| 84484 |
|
20,281 |
18,171 |
$197K |
| 71275 |
|
1,704 |
1,654 |
$189K |
| 80307 |
|
9,752 |
9,202 |
$184K |
| 45380 |
|
222 |
156 |
$166K |
| 96365 |
|
4,687 |
4,513 |
$150K |
| 81001 |
|
27,504 |
26,258 |
$140K |
| 73610 |
|
2,191 |
2,164 |
$131K |
| T5999 |
Supply, nos |
686 |
642 |
$130K |
| 87086 |
|
12,639 |
12,126 |
$128K |
| 97110 |
|
6,756 |
3,229 |
$125K |
| V2632 |
Post chmbr intraocular lens |
930 |
904 |
$124K |
| 83690 |
|
22,943 |
21,597 |
$120K |
| 81003 |
|
12,681 |
12,190 |
$119K |
| 94640 |
|
7,774 |
6,737 |
$119K |
| 97750 |
|
4,793 |
2,885 |
$114K |
| 0160 |
|
231 |
210 |
$113K |
| 96361 |
|
5,472 |
4,842 |
$111K |
| 73630 |
|
2,393 |
2,342 |
$110K |
| 82962 |
|
7,476 |
5,363 |
$101K |
| 76815 |
|
2,178 |
1,251 |
$99K |
| 73030 |
|
1,873 |
1,839 |
$94K |
| Z9725 |
|
3,000 |
2,959 |
$90K |
| 76700 |
|
2,788 |
2,738 |
$90K |
| 73562 |
|
1,958 |
1,926 |
$89K |
| 87081 |
|
3,526 |
3,475 |
$87K |
| 73130 |
|
1,661 |
1,637 |
$87K |
| 93971 |
|
1,949 |
1,893 |
$86K |
| C1713 |
Anchor/screw bn/bn,tis/bn |
97 |
94 |
$83K |
| 84703 |
|
13,751 |
13,142 |
$82K |
| 76856 |
|
2,530 |
2,473 |
$82K |
| 76830 |
|
2,044 |
1,998 |
$78K |
| 87491 |
|
3,975 |
3,886 |
$77K |
| 73110 |
|
1,465 |
1,429 |
$76K |
| 78452 |
|
282 |
266 |
$76K |
| 96376 |
|
2,314 |
1,925 |
$72K |
| 76801 |
|
2,509 |
2,262 |
$69K |
| 87635 |
|
2,537 |
2,459 |
$67K |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
9,523 |
9,214 |
$65K |
| Q0111 |
Wet mounts/ w preparations |
2,668 |
2,604 |
$64K |
| 74018 |
|
1,699 |
1,658 |
$63K |
| 81025 |
|
8,062 |
7,854 |
$62K |
| 87040 |
|
6,494 |
5,839 |
$62K |
| 87077 |
|
3,529 |
3,426 |
$61K |
| A9270 |
Non-covered item or service |
11,102 |
4,137 |
$61K |
| J8540 |
Oral dexamethasone |
1,072 |
1,049 |
$60K |
| 0324 |
|
416 |
404 |
$59K |
| 10060 |
|
579 |
565 |
$57K |
| 83605 |
|
8,437 |
7,912 |
$57K |
| 83880 |
|
5,312 |
5,036 |
$57K |
| Z7610 |
|
9,674 |
4,918 |
$57K |
| 97139 |
|
8,107 |
2,281 |
$57K |
| 76817 |
|
1,948 |
1,761 |
$55K |
| 43235 |
|
101 |
97 |
$53K |
| 0760 |
|
1,048 |
884 |
$52K |
| 85027 |
|
15,594 |
14,873 |
$52K |
| J7040 |
Normal saline solution infus |
4,484 |
2,588 |
$51K |
| 87502 |
|
1,865 |
1,836 |
$49K |
| 84702 |
|
5,261 |
4,735 |
$47K |
| J2704 |
Inj, propofol, 10 mg |
6,738 |
6,321 |
$46K |
| 72100 |
|
905 |
890 |
$44K |
| J2250 |
Inj midazolam hydrochloride |
5,941 |
5,467 |
$43K |
| J3010 |
Fentanyl citrate injection |
9,422 |
8,578 |
$42K |
| 73140 |
|
564 |
556 |
$40K |
| 96360 |
|
1,884 |
1,802 |
$40K |
| 29848 |
|
127 |
126 |
$38K |
| 87631 |
|
1,196 |
1,172 |
$38K |
| 73080 |
|
596 |
587 |
$35K |
| 87591 |
|
3,979 |
3,891 |
$34K |
| Q4051 |
Splint supplies misc |
29 |
16 |
$34K |
| J7030 |
Normal saline solution infus |
15,642 |
13,079 |
$33K |
| 87880 |
|
3,741 |
3,693 |
$31K |
| 97803 |
|
839 |
745 |
$29K |
| J1885 |
Ketorolac tromethamine inj |
19,817 |
18,777 |
$28K |
| 93306 |
|
296 |
278 |
$28K |
| 0720 |
|
479 |
379 |
$27K |
| 76705 |
|
565 |
563 |
$26K |
| 0949 |
|
623 |
515 |
$25K |
| 12001 |
|
421 |
415 |
$25K |
| 83735 |
|
5,134 |
4,530 |
$25K |
| 70496 |
|
216 |
208 |
$24K |
| J1815 |
Insulin injection |
2,453 |
1,635 |
$24K |
| 70486 |
|
353 |
350 |
$24K |
| 74174 |
|
81 |
81 |
$23K |
| 72131 |
|
274 |
270 |
$23K |
| G0500 |
Mod sedat endo service >5yrs |
211 |
207 |
$22K |
| 96366 |
|
850 |
717 |
$22K |
| 0254 |
|
16 |
16 |
$22K |
| 70498 |
|
176 |
175 |
$21K |
| J2405 |
Ondansetron hcl injection |
10,148 |
9,519 |
$21K |
| 80076 |
|
2,264 |
2,190 |
$20K |
| 73090 |
|
323 |
322 |
$19K |
| 29125 |
|
709 |
680 |
$19K |
| 85610 |
|
6,587 |
6,271 |
$18K |
| 73502 |
|
539 |
522 |
$18K |
| G0463 |
Hospital outpt clinic visit |
1,175 |
1,061 |
$18K |
| 85379 |
|
3,144 |
3,070 |
$17K |
| 83036 |
|
1,370 |
1,324 |
$17K |
| 12011 |
|
254 |
247 |
$16K |
| 94644 |
|
976 |
907 |
$16K |
| 99291 |
|
107 |
107 |
$16K |
| 87661 |
|
1,510 |
1,487 |
$15K |
| 45385 |
|
18 |
17 |
$14K |
| 86141 |
|
2,368 |
2,282 |
$14K |
| 93017 |
|
291 |
274 |
$14K |
| J0690 |
Cefazolin sodium injection |
2,301 |
2,159 |
$13K |
| J1100 |
Dexamethasone sodium phos |
6,268 |
6,070 |
$13K |
| 86901 |
|
3,803 |
3,662 |
$13K |
| 85730 |
|
3,184 |
3,088 |
$13K |
| 82803 |
|
930 |
898 |
$13K |
| 0301 |
|
123 |
62 |
$12K |
| 0370 |
|
216 |
211 |
$12K |
| 80061 |
|
1,172 |
1,128 |
$12K |
| 86885 |
|
1,437 |
1,380 |
$12K |
| 90471 |
|
2,106 |
1,952 |
$12K |
| 73590 |
|
329 |
325 |
$11K |
| 93970 |
|
137 |
132 |
$11K |
| 90715 |
|
1,667 |
1,648 |
$11K |
| 76805 |
|
314 |
308 |
$11K |
| 84145 |
|
1,634 |
1,579 |
$11K |
| 87186 |
|
2,876 |
2,793 |
$11K |
| J7120 |
Ringers lactate infusion |
3,449 |
2,986 |
$11K |
| 0761 |
|
152 |
126 |
$11K |
| J2785 |
Regadenoson injection |
273 |
257 |
$10K |
| J2270 |
Morphine sulfate injection |
5,168 |
4,333 |
$10K |
| 92507 |
|
435 |
254 |
$9K |
| J0696 |
Ceftriaxone sodium injection |
4,166 |
3,945 |
$9K |
| 97530 |
|
1,251 |
825 |
$9K |
| 84443 |
|
1,345 |
1,315 |
$8K |
| J7510 |
Prednisolone oral per 5 mg |
29 |
29 |
$8K |
| 71260 |
|
37 |
37 |
$7K |
| 82010 |
|
802 |
758 |
$7K |
| 88304 |
|
93 |
91 |
$7K |
| 82550 |
|
902 |
813 |
$7K |
| 97165 |
|
276 |
219 |
$7K |
| 85007 |
|
2,326 |
2,219 |
$6K |
| 99202 |
|
13 |
12 |
$6K |
| 87147 |
|
657 |
641 |
$6K |
| 70551 |
|
65 |
64 |
$6K |
| 85651 |
|
926 |
884 |
$6K |
| 97802 |
|
83 |
79 |
$6K |
| J1200 |
Diphenhydramine hcl injectio |
3,784 |
3,541 |
$5K |
| 97161 |
|
207 |
145 |
$5K |
| 87637 |
|
470 |
456 |
$5K |
| J3475 |
Inj magnesium sulfate |
233 |
189 |
$5K |
| J2765 |
Metoclopramide hcl injection |
3,691 |
3,483 |
$5K |
| J0780 |
Prochlorperazine injection |
1,881 |
1,789 |
$5K |
| L1830 |
Ko immob canvas long pre ots |
81 |
81 |
$5K |
| 86900 |
|
2,119 |
2,042 |
$5K |
| 97799 |
|
795 |
200 |
$5K |
| 87428 |
|
214 |
211 |
$5K |
| 70491 |
|
43 |
40 |
$4K |
| U0005 |
Infec agen detec ampli probe |
2,671 |
2,584 |
$4K |
| J2060 |
Lorazepam injection |
2,145 |
1,845 |
$4K |
| 80069 |
|
327 |
119 |
$4K |
| 99153 |
Mod sedat endo service >5yrs |
53 |
52 |
$4K |
| 76870 |
|
79 |
78 |
$4K |
| 97140 |
|
149 |
84 |
$4K |
| 73564 |
|
78 |
78 |
$3K |
| A9500 |
Tc99m sestamibi |
162 |
146 |
$3K |
| L4386 |
Non-pneum walk boot pre cst |
46 |
46 |
$3K |
| C9399 |
Unclassified drugs or biolog |
128 |
127 |
$3K |
| 86880 |
|
614 |
592 |
$3K |
| A9502 |
Tc99m tetrofosmin |
127 |
125 |
$2K |
| 47563 |
|
12 |
12 |
$2K |
| 96367 |
|
248 |
237 |
$2K |
| J1644 |
Inj heparin sodium per 1000u |
893 |
457 |
$2K |
| J0665 |
Inj, bupivacaine, nos, 0.5mg |
627 |
614 |
$2K |
| 71020 |
|
56 |
34 |
$2K |
| 72128 |
|
13 |
13 |
$2K |
| J0171 |
Adrenalin epinephrine inject |
452 |
440 |
$2K |
| 0272 |
|
153 |
146 |
$2K |
| 29105 |
|
45 |
42 |
$2K |
| 97162 |
|
84 |
84 |
$2K |
| X4110 |
|
54 |
12 |
$2K |
| 82553 |
|
116 |
107 |
$2K |
| J3486 |
Ziprasidone mesylate |
120 |
92 |
$1K |
| 97010 |
|
99 |
25 |
$1K |
| J1650 |
Inj enoxaparin sodium |
127 |
79 |
$1K |
| 70360 |
|
25 |
24 |
$1K |
| C1781 |
Mesh (implantable) |
12 |
12 |
$1K |
| J2930 |
Methylprednisolone injection |
493 |
458 |
$1K |
| 99070 |
|
162 |
57 |
$1K |
| S0020 |
Injection, bupivicaine hydro |
224 |
220 |
$1K |
| G0121 |
Colon ca scrn not hi rsk ind |
12 |
12 |
$1K |
| 86308 |
|
341 |
334 |
$994.08 |
| 29515 |
|
107 |
103 |
$966.52 |
| J7050 |
Normal saline solution infus |
485 |
409 |
$915.56 |
| 92610 |
|
38 |
36 |
$905.89 |
| Z7500 |
|
27 |
24 |
$903.65 |
| 12002 |
|
12 |
12 |
$845.34 |
| G8980 |
Mobility d/c status |
120 |
105 |
$801.79 |
| 92522 |
|
44 |
42 |
$794.24 |
| 82140 |
|
156 |
147 |
$789.07 |
| 84439 |
|
49 |
48 |
$777.39 |
| 84100 |
|
258 |
248 |
$700.54 |
| 76770 |
|
29 |
25 |
$684.84 |
| 74019 |
|
25 |
25 |
$671.58 |
| J1630 |
Haloperidol injection |
408 |
354 |
$636.06 |
| 29530 |
|
38 |
37 |
$440.77 |
| G8978 |
Mobility current status |
347 |
322 |
$397.87 |
| 73560 |
|
12 |
12 |
$332.68 |
| J1170 |
Hydromorphone injection |
173 |
157 |
$314.51 |
| 76775 |
|
12 |
12 |
$309.02 |
| 94664 |
|
32 |
31 |
$262.71 |
| 29130 |
|
50 |
50 |
$244.56 |
| J0131 |
Inj, acetaminophen (nos) |
26 |
26 |
$201.66 |
| 87634 |
|
15 |
15 |
$172.73 |
| 84132 |
|
19 |
14 |
$155.53 |
| 36600 |
|
31 |
28 |
$133.10 |
| J3370 |
Vancomycin hcl injection |
146 |
120 |
$129.03 |
| J0360 |
Hydralazine hcl injection |
41 |
38 |
$128.38 |
| 97166 |
|
110 |
95 |
$124.74 |
| G8979 |
Mobility goal status |
413 |
383 |
$113.46 |
| 86780 |
|
27 |
24 |
$98.80 |
| S0028 |
Injection, famotidine, 20 mg |
50 |
48 |
$93.73 |
| 80164 |
|
43 |
39 |
$92.40 |
| S0164 |
Injection pantroprazole |
72 |
56 |
$78.97 |
| J2470 |
Inj pantoprazole sodium 40mg |
32 |
25 |
$77.76 |
| 88720 |
|
14 |
14 |
$70.30 |
| 82570 |
|
12 |
12 |
$61.00 |
| M0243 |
Casirivi and imdevi inj |
19 |
18 |
$50.28 |
| J0500 |
Dicyclomine injection |
55 |
55 |
$48.89 |
| J2919 |
Inj, methylpred sod succ 5mg |
28 |
28 |
$48.57 |
| J1953 |
Levetiracetam injection |
15 |
13 |
$33.28 |
| C9113 |
Inj pantoprazole sodium, via |
45 |
41 |
$22.00 |
| Q9969 |
Non-heu tc-99m add-on/dose |
408 |
397 |
$14.65 |
| J1940 |
Furosemide injection |
23 |
14 |
$3.13 |
| 84550 |
|
14 |
14 |
$1.10 |
| G8987 |
Self care current status |
40 |
40 |
$0.00 |
| 71101 |
|
14 |
14 |
$0.00 |
| G8988 |
Self care goal status |
46 |
43 |
$0.00 |