| Code | Description | Claims | Beneficiaries | Total Paid |
| G0463 |
Hospital outpt clinic visit |
46,558 |
40,111 |
$3.36M |
| C9803 |
Hopd covid-19 spec collect |
8,082 |
7,454 |
$146K |
| G0008 |
Admin influenza virus vac |
5,130 |
5,085 |
$136K |
| 90832 |
|
1,205 |
1,005 |
$109K |
| 90677 |
|
562 |
556 |
$109K |
| 90471 |
|
3,856 |
3,733 |
$101K |
| 99391 |
|
1,615 |
1,450 |
$100K |
| 99395 |
|
1,235 |
1,200 |
$80K |
| 99396 |
|
1,246 |
1,194 |
$80K |
| 99392 |
|
1,187 |
1,174 |
$75K |
| 0002A |
|
1,849 |
1,828 |
$71K |
| 90791 |
|
726 |
714 |
$69K |
| 0001A |
|
1,679 |
1,678 |
$60K |
| 99393 |
|
939 |
937 |
$59K |
| G0009 |
Admin pneumococcal vaccine |
1,744 |
1,723 |
$48K |
| 90686 |
|
4,503 |
4,463 |
$44K |
| 99394 |
|
617 |
610 |
$41K |
| Q0222 |
Bebtelovimab 175 mg |
30 |
30 |
$34K |
| 90834 |
|
364 |
303 |
$26K |
| 97110 |
|
1,965 |
1,054 |
$25K |
| 96372 |
|
980 |
917 |
$23K |
| 90651 |
|
451 |
446 |
$16K |
| 97140 |
|
1,475 |
675 |
$16K |
| 80061 |
|
1,479 |
1,457 |
$14K |
| 0124A |
|
861 |
852 |
$14K |
| 90732 |
|
256 |
252 |
$11K |
| M0243 |
Casirivi and imdevi inj |
39 |
39 |
$11K |
| Q3014 |
Telehealth facility fee |
773 |
713 |
$10K |
| 97810 |
|
598 |
588 |
$9K |
| 84443 |
|
1,337 |
1,317 |
$9K |
| 80053 |
|
2,447 |
2,391 |
$8K |
| 87591 |
|
1,111 |
1,033 |
$8K |
| 87491 |
|
1,112 |
1,033 |
$8K |
| 0054A |
|
427 |
419 |
$8K |
| 87624 |
|
726 |
708 |
$7K |
| 90670 |
|
813 |
804 |
$7K |
| M0222 |
Bebtelovimab injection |
47 |
47 |
$7K |
| 80305 |
|
3,677 |
3,317 |
$5K |
| 87389 |
|
611 |
605 |
$5K |
| 88142 |
|
501 |
487 |
$4K |
| 82306 |
|
286 |
284 |
$4K |
| 87636 |
|
50 |
50 |
$4K |
| 85025 |
|
1,755 |
1,707 |
$4K |
| 90662 |
|
446 |
443 |
$4K |
| 93005 |
|
572 |
565 |
$4K |
| 83036 |
|
1,556 |
1,534 |
$4K |
| 86803 |
|
631 |
618 |
$3K |
| 36415 |
|
4,327 |
4,052 |
$3K |
| 90750 |
|
30 |
26 |
$3K |
| M0247 |
Sotrovimab infusion |
16 |
16 |
$3K |
| 88175 |
|
143 |
143 |
$2K |
| 0031A |
|
67 |
67 |
$2K |
| 80048 |
|
498 |
454 |
$2K |
| U0003 |
Cov-19 amp prb hgh thruput |
32 |
32 |
$2K |
| 91320 |
|
224 |
224 |
$1K |
| 82728 |
|
172 |
171 |
$1K |
| 98926 |
|
967 |
865 |
$1K |
| 97161 |
|
42 |
37 |
$1K |
| 87481 |
|
172 |
90 |
$1K |
| 86780 |
|
99 |
97 |
$1K |
| 83655 |
|
238 |
228 |
$1K |
| 97813 |
|
78 |
77 |
$1K |
| 87086 |
|
778 |
741 |
$913.81 |
| G0010 |
Admin hepatitis b vaccine |
25 |
25 |
$864.50 |
| 81025 |
|
829 |
798 |
$828.16 |
| 99188 |
|
36 |
36 |
$828.00 |
| 82607 |
|
106 |
103 |
$742.28 |
| 83550 |
|
148 |
148 |
$729.20 |
| 0012A |
|
48 |
43 |
$705.60 |
| 0052A |
|
31 |
28 |
$690.30 |
| 87511 |
|
92 |
90 |
$679.82 |
| 87661 |
|
93 |
91 |
$636.32 |
| 85027 |
|
232 |
227 |
$617.48 |
| 82043 |
|
506 |
494 |
$572.25 |
| 83540 |
|
151 |
151 |
$559.21 |
| 90480 |
|
281 |
281 |
$459.29 |
| 0004A |
|
748 |
746 |
$422.24 |
| 98925 |
|
683 |
635 |
$418.92 |
| 87070 |
|
366 |
354 |
$370.66 |
| 85610 |
|
312 |
186 |
$360.81 |
| 0011A |
|
47 |
38 |
$335.00 |
| 82746 |
|
47 |
45 |
$309.14 |
| 90734 |
|
139 |
136 |
$292.47 |
| 98927 |
|
133 |
126 |
$284.56 |
| 87502 |
|
75 |
75 |
$276.85 |
| 90619 |
|
67 |
67 |
$260.00 |
| 80307 |
|
15 |
13 |
$224.45 |
| 81003 |
|
604 |
572 |
$209.17 |
| 90716 |
|
44 |
44 |
$163.34 |
| 83037 |
|
1,439 |
1,420 |
$145.94 |
| D1206 |
|
12 |
12 |
$144.00 |
| 90681 |
|
274 |
273 |
$108.65 |
| 90710 |
|
13 |
13 |
$85.00 |
| 81002 |
|
1,044 |
983 |
$76.12 |
| 85018 |
|
99 |
97 |
$68.73 |
| 87186 |
|
30 |
27 |
$60.55 |
| 90715 |
|
1,292 |
1,267 |
$47.00 |
| 84439 |
|
12 |
12 |
$46.96 |
| 87880 |
|
104 |
99 |
$46.84 |
| 81001 |
|
83 |
79 |
$44.58 |
| 0064A |
|
121 |
120 |
$40.50 |
| 0072A |
|
174 |
167 |
$40.50 |
| 85652 |
|
43 |
42 |
$37.80 |
| 87077 |
|
30 |
27 |
$37.38 |
| 0003A |
|
22 |
22 |
$34.58 |
| 83735 |
|
13 |
12 |
$33.50 |
| 90744 |
|
148 |
147 |
$16.00 |
| 87210 |
|
19 |
12 |
$8.72 |
| J1030 |
Methylprednisolone 40 mg inj |
40 |
38 |
$7.68 |
| 36416 |
|
2,639 |
2,574 |
$0.00 |
| 90698 |
|
345 |
342 |
$0.00 |
| 90696 |
|
17 |
17 |
$0.00 |
| 90474 |
|
283 |
282 |
$0.00 |
| 90697 |
|
200 |
200 |
$0.00 |
| 91306 |
|
104 |
103 |
$0.00 |
| 91305 |
|
366 |
351 |
$0.00 |
| 91307 |
|
277 |
266 |
$0.00 |
| G0145 |
Scr c/v cyto,thinlayer,rescr |
81 |
79 |
$0.00 |
| 91301 |
|
94 |
80 |
$0.00 |
| 91303 |
|
43 |
43 |
$0.00 |
| 90671 |
|
278 |
277 |
$0.00 |
| 90633 |
|
424 |
421 |
$0.00 |
| J1050 |
Medroxyprogesterone acetate |
437 |
412 |
$0.00 |
| 90707 |
|
83 |
83 |
$0.00 |
| 90472 |
|
1,980 |
1,948 |
$0.00 |
| 91312 |
|
568 |
563 |
$0.00 |
| 0071A |
|
192 |
192 |
$0.00 |
| 91300 |
|
4,054 |
3,720 |
$0.00 |
| 87804 |
|
24 |
12 |
$0.00 |
| 91321 |
|
32 |
32 |
$0.00 |
| 90700 |
|
12 |
12 |
$0.00 |