| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 0450 |
|
121,640 |
108,234 |
$6.49M |
| 87637 |
|
7,930 |
7,633 |
$1.63M |
| 87636 |
|
7,579 |
7,430 |
$1.59M |
| 74177 |
|
4,571 |
4,462 |
$1.32M |
| 96374 |
|
15,735 |
14,631 |
$1.31M |
| J3490 |
Drugs unclassified injection |
98,067 |
50,440 |
$1.12M |
| 99199 |
|
7,655 |
6,541 |
$1.03M |
| 93005 |
|
29,922 |
27,076 |
$872K |
| 96375 |
|
12,888 |
11,321 |
$810K |
| 70450 |
|
6,001 |
5,785 |
$708K |
| 80053 |
|
51,555 |
46,459 |
$562K |
| 87635 |
|
7,605 |
7,375 |
$530K |
| 96365 |
|
4,887 |
4,657 |
$529K |
| 96372 |
|
12,725 |
11,591 |
$471K |
| 85025 |
|
57,704 |
50,226 |
$448K |
| 80307 |
|
5,332 |
4,932 |
$432K |
| 71275 |
|
1,488 |
1,456 |
$390K |
| Z7502 |
|
9,876 |
9,743 |
$369K |
| 74176 |
|
2,354 |
2,287 |
$342K |
| 99284 |
|
6,119 |
5,533 |
$317K |
| 71046 |
|
11,679 |
11,325 |
$309K |
| 96361 |
|
6,229 |
5,719 |
$286K |
| 84484 |
|
26,486 |
17,552 |
$272K |
| U0003 |
Cov-19 amp prb hgh thruput |
2,688 |
2,653 |
$234K |
| 72125 |
|
1,389 |
1,360 |
$218K |
| 36430 |
|
3,514 |
1,687 |
$217K |
| 87491 |
|
4,551 |
4,454 |
$216K |
| 87591 |
|
4,550 |
4,453 |
$214K |
| 76705 |
|
3,098 |
2,991 |
$199K |
| 71045 |
|
13,331 |
12,513 |
$197K |
| 76801 |
|
2,195 |
1,932 |
$190K |
| 93971 |
|
1,469 |
1,420 |
$176K |
| 82077 |
|
2,971 |
2,772 |
$171K |
| 87502 |
|
1,582 |
1,563 |
$168K |
| 96360 |
|
1,818 |
1,779 |
$151K |
| 93306 |
|
597 |
591 |
$149K |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
14,528 |
7,416 |
$148K |
| 83880 |
|
4,342 |
4,048 |
$145K |
| J7030 |
Normal saline solution infus |
13,840 |
12,139 |
$145K |
| 83690 |
|
19,492 |
17,943 |
$142K |
| 76856 |
|
1,865 |
1,825 |
$134K |
| 99281 |
|
2,588 |
2,350 |
$128K |
| 99283 |
|
2,959 |
2,668 |
$126K |
| 99285 |
|
1,540 |
1,445 |
$121K |
| 70496 |
|
443 |
440 |
$119K |
| 87651 |
|
3,027 |
2,982 |
$118K |
| 70498 |
|
428 |
424 |
$115K |
| 0762 |
|
1,038 |
483 |
$106K |
| 90715 |
|
1,720 |
1,694 |
$98K |
| 83735 |
|
13,579 |
11,992 |
$95K |
| 87040 |
|
6,528 |
4,196 |
$87K |
| 80143 |
|
1,418 |
1,289 |
$87K |
| 83605 |
|
8,033 |
6,165 |
$86K |
| 84703 |
|
11,505 |
10,931 |
$81K |
| J1885 |
Ketorolac tromethamine inj |
10,176 |
9,596 |
$79K |
| 80179 |
|
1,348 |
1,266 |
$78K |
| 0510 |
|
2,109 |
1,788 |
$77K |
| 94640 |
|
3,014 |
2,680 |
$76K |
| T1999 |
Noc retail items andsupplies |
3,881 |
2,387 |
$74K |
| 73562 |
|
2,511 |
2,442 |
$66K |
| J2405 |
Ondansetron hcl injection |
8,018 |
7,054 |
$65K |
| 73610 |
|
2,311 |
2,257 |
$64K |
| J0131 |
Inj, acetaminophen (nos) |
2,548 |
1,307 |
$62K |
| 73630 |
|
2,335 |
2,277 |
$62K |
| 84443 |
|
3,559 |
3,451 |
$62K |
| 87086 |
|
6,162 |
5,966 |
$60K |
| 84702 |
|
3,917 |
3,420 |
$57K |
| 82803 |
|
3,903 |
3,708 |
$57K |
| 82947 |
|
11,304 |
8,243 |
$57K |
| 81001 |
|
16,486 |
15,739 |
$56K |
| 96366 |
|
969 |
898 |
$53K |
| J2270 |
Morphine sulfate injection |
4,492 |
3,799 |
$51K |
| 73030 |
|
1,839 |
1,784 |
$50K |
| 99070 |
|
1,918 |
1,066 |
$50K |
| 96376 |
|
2,084 |
1,417 |
$49K |
| J7120 |
Ringers lactate infusion |
4,584 |
4,030 |
$49K |
| 0272 |
|
421 |
409 |
$44K |
| 70486 |
|
312 |
309 |
$43K |
| 73130 |
|
1,567 |
1,524 |
$43K |
| J0696 |
Ceftriaxone sodium injection |
3,956 |
3,668 |
$41K |
| 81025 |
|
8,656 |
8,419 |
$40K |
| J1100 |
Dexamethasone sodium phos |
3,525 |
3,371 |
$39K |
| 0250 |
|
4,305 |
3,309 |
$35K |
| 71260 |
|
197 |
195 |
$34K |
| 93970 |
|
165 |
164 |
$32K |
| J1170 |
Hydromorphone injection |
2,519 |
1,966 |
$32K |
| 78452 |
|
88 |
88 |
$31K |
| 85379 |
|
2,819 |
2,744 |
$31K |
| 80048 |
|
3,422 |
3,137 |
$30K |
| 74174 |
|
96 |
94 |
$30K |
| J0500 |
Dicyclomine injection |
295 |
283 |
$28K |
| J1815 |
Insulin injection |
1,625 |
739 |
$27K |
| J2765 |
Metoclopramide hcl injection |
3,231 |
2,932 |
$27K |
| 85610 |
|
6,519 |
6,159 |
$26K |
| 73110 |
|
925 |
890 |
$25K |
| 85730 |
|
4,060 |
3,899 |
$25K |
| 87186 |
|
2,278 |
2,129 |
$24K |
| 81003 |
|
9,539 |
8,327 |
$24K |
| J3475 |
Inj magnesium sulfate |
2,093 |
1,853 |
$23K |
| 72131 |
|
168 |
167 |
$22K |
| 71250 |
|
198 |
186 |
$22K |
| 0270 |
|
750 |
393 |
$22K |
| 87077 |
|
2,184 |
2,000 |
$21K |
| 73502 |
|
493 |
483 |
$21K |
| J0780 |
Prochlorperazine injection |
1,113 |
1,030 |
$21K |
| 70551 |
|
101 |
100 |
$20K |
| J1200 |
Diphenhydramine hcl injectio |
2,562 |
2,335 |
$20K |
| 96367 |
|
308 |
295 |
$19K |
| S0164 |
Injection pantroprazole |
1,233 |
975 |
$19K |
| Z7610 |
|
1,921 |
1,115 |
$19K |
| A9502 |
Tc99m tetrofosmin |
88 |
88 |
$17K |
| 97750 |
|
304 |
289 |
$17K |
| 76830 |
|
220 |
217 |
$16K |
| Z9725 |
|
334 |
327 |
$14K |
| 90471 |
|
1,979 |
1,920 |
$13K |
| J2060 |
Lorazepam injection |
1,684 |
1,458 |
$13K |
| 76770 |
|
165 |
164 |
$13K |
| 72100 |
|
383 |
379 |
$13K |
| 73080 |
|
444 |
437 |
$13K |
| J2785 |
Regadenoson injection |
43 |
42 |
$12K |
| L4350 |
Ankle control ortho pre ots |
144 |
141 |
$12K |
| J3010 |
Fentanyl citrate injection |
1,564 |
1,416 |
$12K |
| 73140 |
|
637 |
618 |
$12K |
| 87210 |
|
2,433 |
2,378 |
$11K |
| 82550 |
|
1,582 |
1,425 |
$11K |
| 87389 |
|
418 |
415 |
$10K |
| 86140 |
|
1,680 |
1,626 |
$10K |
| 82805 |
|
307 |
278 |
$9K |
| J2930 |
Methylprednisolone injection |
461 |
371 |
$9K |
| 87400 |
|
1,250 |
1,232 |
$9K |
| 86901 |
|
2,619 |
2,494 |
$9K |
| 0202U |
|
17 |
17 |
$8K |
| 94644 |
|
266 |
250 |
$8K |
| J0137 |
Inj, acetaminophen (hikma) |
295 |
141 |
$8K |
| 87880 |
|
782 |
770 |
$7K |
| 73590 |
|
318 |
308 |
$7K |
| 84100 |
|
1,437 |
1,238 |
$7K |
| 93017 |
|
80 |
78 |
$6K |
| 83036 |
|
468 |
444 |
$6K |
| 86900 |
|
1,958 |
1,643 |
$6K |
| 76817 |
|
78 |
76 |
$6K |
| 86850 |
|
1,216 |
1,158 |
$5K |
| 76870 |
|
109 |
106 |
$5K |
| 84439 |
|
547 |
536 |
$5K |
| J7611 |
Albuterol non-comp con |
486 |
333 |
$5K |
| L3908 |
Who cock-up nonmolde pre ots |
95 |
95 |
$5K |
| J1953 |
Levetiracetam injection |
208 |
110 |
$5K |
| 12001 |
|
189 |
186 |
$4K |
| J2001 |
Lidocaine injection |
639 |
611 |
$4K |
| 0636 |
|
704 |
453 |
$4K |
| 76815 |
|
58 |
58 |
$4K |
| 0360 |
|
16 |
16 |
$4K |
| L1830 |
Ko immob canvas long pre ots |
49 |
48 |
$4K |
| 97139 |
|
146 |
59 |
$4K |
| U0005 |
Infec agen detec ampli probe |
1,185 |
1,174 |
$4K |
| 10060 |
|
151 |
147 |
$4K |
| 74018 |
|
158 |
157 |
$4K |
| 12011 |
|
98 |
95 |
$3K |
| 82009 |
|
681 |
628 |
$3K |
| 84145 |
|
83 |
80 |
$3K |
| 87420 |
|
559 |
551 |
$3K |
| J7040 |
Normal saline solution infus |
319 |
311 |
$3K |
| 87081 |
|
267 |
266 |
$2K |
| 87634 |
|
25 |
25 |
$2K |
| 73090 |
|
101 |
94 |
$2K |
| 82731 |
|
30 |
28 |
$2K |
| 76700 |
|
27 |
25 |
$2K |
| 29125 |
|
200 |
191 |
$2K |
| 80061 |
|
91 |
89 |
$2K |
| J2704 |
Inj, propofol, 10 mg |
135 |
112 |
$2K |
| 97110 |
|
183 |
79 |
$2K |
| 0710 |
|
42 |
42 |
$2K |
| 36415 |
|
26,136 |
21,645 |
$2K |
| J2919 |
Inj, methylpred sod succ 5mg |
57 |
43 |
$1K |
| 85652 |
|
466 |
452 |
$1K |
| J1940 |
Furosemide injection |
151 |
102 |
$1K |
| 71101 |
|
38 |
38 |
$1K |
| 12002 |
|
53 |
52 |
$1K |
| J1650 |
Inj enoxaparin sodium |
49 |
26 |
$1K |
| J7050 |
Normal saline solution infus |
90 |
71 |
$857.85 |
| 86592 |
|
152 |
151 |
$833.25 |
| J0360 |
Hydralazine hcl injection |
51 |
43 |
$794.89 |
| 74019 |
|
26 |
26 |
$786.53 |
| J8540 |
Oral dexamethasone |
1,428 |
1,399 |
$709.64 |
| 82553 |
|
54 |
48 |
$692.97 |
| S0028 |
Injection, famotidine, 20 mg |
790 |
727 |
$609.27 |
| J2550 |
Promethazine hcl injection |
66 |
61 |
$554.63 |
| J3370 |
Vancomycin hcl injection |
34 |
28 |
$492.30 |
| J2250 |
Inj midazolam hydrochloride |
63 |
54 |
$477.43 |
| J7620 |
Albuterol ipratrop non-comp |
2,943 |
2,538 |
$461.25 |
| 97161 |
|
27 |
27 |
$440.48 |
| 73564 |
|
13 |
13 |
$410.56 |
| J2470 |
Inj pantoprazole sodium 40mg |
78 |
68 |
$397.71 |
| 99282 |
|
13 |
13 |
$388.25 |
| J3480 |
Inj potassium chloride |
164 |
119 |
$367.40 |
| J7613 |
Albuterol non-comp unit |
534 |
477 |
$355.71 |
| 87088 |
|
37 |
37 |
$336.09 |
| 88305 |
|
12 |
12 |
$329.28 |
| J1171 |
Inj, hydromorphone, 0.1 mg |
85 |
52 |
$306.28 |
| J7512 |
Prednisone ir or dr oral 1mg |
2,256 |
2,039 |
$280.93 |
| J2272 |
Inj, morphine (fresenius) |
16 |
16 |
$278.10 |
| J1836 |
Inj, metronidazole, 10 mg |
31 |
25 |
$245.73 |
| 72170 |
|
13 |
13 |
$237.05 |
| 86308 |
|
42 |
42 |
$221.79 |
| 73660 |
|
12 |
12 |
$213.75 |
| 70360 |
|
12 |
12 |
$207.82 |
| 87045 |
|
14 |
13 |
$188.39 |
| 82140 |
|
15 |
14 |
$159.30 |
| Q0162 |
Ondansetron oral |
1,394 |
1,322 |
$150.70 |
| J1630 |
Haloperidol injection |
17 |
13 |
$148.24 |
| 87070 |
|
17 |
16 |
$144.60 |
| J7644 |
Ipratropium bromide non-comp |
313 |
289 |
$144.32 |
| 29515 |
|
12 |
12 |
$123.96 |
| 86701 |
|
12 |
12 |
$104.76 |
| 87046 |
|
26 |
13 |
$99.54 |
| 97530 |
|
14 |
13 |
$71.69 |
| 69209 |
|
12 |
12 |
$71.63 |
| 84132 |
|
16 |
12 |
$66.54 |
| 87205 |
|
16 |
13 |
$58.02 |
| J7626 |
Budesonide non-comp unit |
63 |
33 |
$9.18 |
| 0250R |
|
405 |
365 |
$0.00 |
| J7510 |
Prednisolone oral per 5 mg |
14 |
14 |
$0.00 |