| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 80053 |
|
4,309 |
3,335 |
$137K |
| 87426 |
|
3,270 |
2,795 |
$100K |
| 70450 |
|
882 |
738 |
$88K |
| 74177 |
|
372 |
313 |
$60K |
| 80048 |
|
1,349 |
1,081 |
$46K |
| 85025 |
|
5,395 |
4,159 |
$42K |
| 80307 |
|
809 |
687 |
$41K |
| 74176 |
|
510 |
422 |
$40K |
| 84484 |
|
1,860 |
1,382 |
$28K |
| 83880 |
|
951 |
777 |
$26K |
| 72125 |
|
89 |
82 |
$26K |
| 93005 |
|
2,552 |
1,976 |
$25K |
| 99283 |
|
892 |
642 |
$25K |
| 71045 |
|
2,323 |
1,880 |
$24K |
| 99285 |
|
695 |
423 |
$20K |
| 99284 |
|
1,010 |
644 |
$19K |
| 99499 |
|
1,137 |
959 |
$18K |
| 87400 |
|
3,703 |
2,122 |
$18K |
| 36415 |
|
1,763 |
1,293 |
$17K |
| 83690 |
|
1,384 |
1,140 |
$16K |
| 82550 |
|
1,055 |
830 |
$12K |
| 81001 |
|
3,483 |
2,714 |
$11K |
| 96361 |
|
210 |
163 |
$10K |
| 87086 |
|
1,176 |
940 |
$9K |
| 84145 |
|
244 |
210 |
$9K |
| 84703 |
|
1,259 |
978 |
$9K |
| 96365 |
|
357 |
305 |
$8K |
| 83605 |
|
354 |
296 |
$8K |
| 96372 |
|
381 |
300 |
$8K |
| 82553 |
|
485 |
398 |
$8K |
| 84443 |
|
670 |
578 |
$6K |
| 86901 |
|
249 |
214 |
$6K |
| 96374 |
|
327 |
280 |
$5K |
| 87880 |
|
599 |
522 |
$5K |
| U0002 |
Covid-19 lab test non-cdc |
125 |
95 |
$4K |
| 87430 |
|
704 |
618 |
$4K |
| 71046 |
|
258 |
207 |
$4K |
| 80076 |
|
85 |
76 |
$4K |
| 85610 |
|
826 |
678 |
$3K |
| 87081 |
|
473 |
419 |
$3K |
| 82805 |
|
82 |
70 |
$3K |
| 87420 |
|
433 |
370 |
$3K |
| J2405 |
Ondansetron hcl injection |
906 |
668 |
$3K |
| J1885 |
Ketorolac tromethamine inj |
1,244 |
903 |
$3K |
| J0696 |
Ceftriaxone sodium injection |
568 |
439 |
$2K |
| 85730 |
|
475 |
410 |
$2K |
| 96375 |
|
176 |
153 |
$2K |
| 83735 |
|
325 |
251 |
$2K |
| 85027 |
|
455 |
384 |
$2K |
| 87088 |
|
270 |
218 |
$2K |
| 80320 |
|
189 |
164 |
$2K |
| 86900 |
|
249 |
213 |
$2K |
| 81025 |
|
230 |
206 |
$2K |
| 80329 |
|
250 |
127 |
$2K |
| 82150 |
|
115 |
104 |
$1K |
| 87040 |
|
117 |
99 |
$1K |
| 76830 |
|
26 |
24 |
$1K |
| 82948 |
|
258 |
154 |
$1K |
| 94640 |
|
333 |
239 |
$1K |
| 80061 |
|
149 |
128 |
$1K |
| 86885 |
|
169 |
150 |
$822.41 |
| 87186 |
|
146 |
123 |
$791.84 |
| 73610 |
|
13 |
12 |
$734.97 |
| 80050 |
|
14 |
14 |
$632.71 |
| C9803 |
Hopd covid-19 spec collect |
63 |
57 |
$598.00 |
| 76805 |
|
12 |
12 |
$560.00 |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
169 |
145 |
$406.80 |
| 84702 |
|
38 |
28 |
$402.52 |
| 99214 |
|
24 |
12 |
$399.78 |
| J1100 |
Dexamethasone sodium phos |
85 |
63 |
$340.63 |
| 73630 |
|
14 |
12 |
$286.72 |
| 73130 |
|
19 |
12 |
$225.00 |
| 85007 |
|
17 |
13 |
$216.00 |
| J2270 |
Morphine sulfate injection |
364 |
276 |
$181.07 |
| 86850 |
|
18 |
14 |
$137.00 |
| 82947 |
|
24 |
13 |
$122.64 |
| 85379 |
|
13 |
12 |
$101.71 |
| J2930 |
Methylprednisolone injection |
17 |
14 |
$79.42 |
| 99001 |
|
121 |
112 |
$78.00 |
| J2704 |
Inj, propofol, 10 mg |
161 |
139 |
$77.29 |
| J2250 |
Inj midazolam hydrochloride |
127 |
111 |
$75.07 |
| 86592 |
|
12 |
12 |
$71.20 |
| 86593 |
|
12 |
12 |
$62.90 |
| J2550 |
Promethazine hcl injection |
16 |
12 |
$38.96 |
| 85014 |
|
12 |
12 |
$30.42 |
| 85018 |
|
12 |
12 |
$30.42 |
| J1170 |
Hydromorphone injection |
31 |
26 |
$24.24 |
| J3490 |
Drugs unclassified injection |
89 |
49 |
$24.00 |
| J3010 |
Fentanyl citrate injection |
31 |
27 |
$13.78 |
| J7121 |
5% dextrose in lac ringers |
17 |
13 |
$11.29 |
| J7030 |
Normal saline solution infus |
188 |
126 |
$2.32 |
| A9270 |
Non-covered item or service |
728 |
146 |
$0.00 |