| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90999 |
|
1,578 |
140 |
$80K |
| Q5105 |
Injection, epoetin alfa-epbx, biosimilar, (retacrit) (for esrd on dialysis), 100 units |
446 |
64 |
$5K |
| Q4081 |
Injection, epoetin alfa, 100 units (for esrd on dialysis) |
88 |
14 |
$2K |
| 83970 |
|
218 |
212 |
$945.72 |
| 82728 |
|
216 |
213 |
$278.82 |
| 83550 |
|
216 |
213 |
$178.77 |
| 84520 |
|
299 |
213 |
$177.57 |
| 83540 |
|
216 |
213 |
$132.35 |
| 80051 |
|
192 |
189 |
$132.21 |
| 84075 |
|
216 |
213 |
$106.03 |
| 82310 |
|
211 |
201 |
$99.62 |
| 82565 |
|
205 |
201 |
$96.12 |
| 84100 |
|
216 |
201 |
$93.91 |
| 82040 |
|
206 |
201 |
$92.94 |
| 86704 |
|
15 |
15 |
$14.04 |
| 86706 |
|
15 |
15 |
$12.50 |
| 87340 |
|
15 |
15 |
$12.05 |
| 84450 |
|
12 |
12 |
$8.72 |
| A4657 |
Syringe, with or without needle, each |
884 |
126 |
$0.00 |
| J1270 |
Injection, doxercalciferol, 1 mcg |
129 |
12 |
$0.00 |