| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 0450 |
|
8,644 |
7,657 |
$1.20M |
| 0112 |
|
66 |
64 |
$586K |
| 0121 |
|
31 |
30 |
$447K |
| 0762 |
|
531 |
326 |
$297K |
| T1999 |
Noc retail items andsupplies |
1,715 |
1,182 |
$130K |
| 0206 |
|
20 |
18 |
$100K |
| 0171 |
Inj, epinephrine (belcher) |
235 |
230 |
$98K |
| 0278 |
|
14 |
14 |
$96K |
| 80053 |
|
9,458 |
8,667 |
$93K |
| 0360 |
|
573 |
521 |
$91K |
| 70553 |
|
140 |
138 |
$79K |
| 96372 |
|
1,210 |
1,090 |
$78K |
| 0200 |
|
15 |
12 |
$70K |
| 96374 |
|
1,042 |
948 |
$66K |
| 96361 |
|
972 |
881 |
$65K |
| 96375 |
|
1,018 |
851 |
$63K |
| G0378 |
Hospital observation per hr |
1,478 |
1,249 |
$54K |
| 84443 |
|
3,857 |
3,788 |
$52K |
| 93306 |
|
1,024 |
985 |
$49K |
| 59425 |
|
677 |
463 |
$44K |
| 85025 |
|
9,389 |
8,565 |
$43K |
| 82306 |
|
1,762 |
1,742 |
$43K |
| 95810 |
|
268 |
262 |
$41K |
| 80061 |
|
3,413 |
3,398 |
$39K |
| 95811 |
|
249 |
243 |
$36K |
| 77067 |
|
439 |
438 |
$35K |
| J2704 |
Inj, propofol, 10 mg |
310 |
296 |
$35K |
| J1885 |
Ketorolac tromethamine inj |
942 |
892 |
$32K |
| 59409 |
|
58 |
58 |
$31K |
| 83036 |
|
2,575 |
2,554 |
$22K |
| 96365 |
|
391 |
336 |
$21K |
| 95886 |
|
479 |
427 |
$21K |
| 93010 |
|
2,683 |
2,360 |
$20K |
| 76856 |
|
464 |
460 |
$20K |
| 76700 |
|
361 |
356 |
$19K |
| 74177 |
|
307 |
294 |
$18K |
| 87491 |
|
641 |
635 |
$17K |
| 96360 |
|
289 |
281 |
$16K |
| 87591 |
|
640 |
634 |
$16K |
| G0480 |
Drug test def 1-7 classes |
552 |
523 |
$16K |
| 71046 |
|
1,358 |
1,309 |
$16K |
| 76830 |
|
348 |
345 |
$15K |
| 70450 |
|
392 |
382 |
$14K |
| 87631 |
|
340 |
331 |
$14K |
| 72110 |
|
336 |
327 |
$13K |
| A9579 |
Gad-base mr contrast nos,1ml |
210 |
198 |
$13K |
| 87086 |
|
1,487 |
1,413 |
$12K |
| J7030 |
Normal saline solution infus |
1,304 |
1,170 |
$12K |
| 87081 |
|
913 |
899 |
$12K |
| 43239 |
|
145 |
95 |
$11K |
| 80307 |
|
538 |
520 |
$11K |
| 73721 |
|
44 |
43 |
$10K |
| 93005 |
|
1,477 |
1,380 |
$10K |
| 99291 |
|
154 |
53 |
$10K |
| J2270 |
Morphine sulfate injection |
493 |
416 |
$10K |
| 87389 |
|
694 |
687 |
$10K |
| 87502 |
|
484 |
478 |
$9K |
| 77063 |
|
429 |
427 |
$9K |
| 73562 |
|
463 |
451 |
$9K |
| 76805 |
|
139 |
138 |
$9K |
| 84439 |
|
1,108 |
1,091 |
$9K |
| 72148 |
|
25 |
25 |
$8K |
| 72050 |
|
211 |
209 |
$8K |
| 84484 |
|
914 |
818 |
$8K |
| 99283 |
|
171 |
155 |
$7K |
| 73630 |
|
321 |
308 |
$7K |
| 73610 |
|
311 |
295 |
$7K |
| 45380 |
|
85 |
63 |
$7K |
| 73030 |
|
397 |
388 |
$7K |
| J3490 |
Drugs unclassified injection |
551 |
336 |
$7K |
| J0696 |
Ceftriaxone sodium injection |
195 |
190 |
$6K |
| 87522 |
Neg quan hep c or qual rna |
207 |
203 |
$6K |
| 99213 |
|
440 |
430 |
$6K |
| 80306 |
|
679 |
653 |
$6K |
| 83970 |
|
209 |
206 |
$6K |
| 84153 |
|
348 |
347 |
$6K |
| 76816 |
|
155 |
154 |
$5K |
| J2405 |
Ondansetron hcl injection |
793 |
674 |
$5K |
| J1100 |
Dexamethasone sodium phos |
224 |
181 |
$5K |
| J2060 |
Lorazepam injection |
188 |
170 |
$5K |
| 84481 |
|
345 |
343 |
$5K |
| 85027 |
|
868 |
783 |
$5K |
| J2930 |
Methylprednisolone injection |
154 |
136 |
$5K |
| 0710 |
|
237 |
222 |
$5K |
| 99233 |
Prolong inpt eval add15 m |
211 |
92 |
$5K |
| 81001 |
|
2,759 |
2,577 |
$5K |
| 93226 |
|
117 |
116 |
$5K |
| 0270 |
|
3,656 |
2,580 |
$5K |
| J1200 |
Diphenhydramine hcl injectio |
242 |
199 |
$4K |
| 82728 |
|
385 |
362 |
$4K |
| 87070 |
|
463 |
458 |
$4K |
| J0131 |
Inj, acetaminophen (nos) |
17 |
17 |
$4K |
| 86803 |
|
354 |
351 |
$4K |
| 73110 |
|
196 |
184 |
$4K |
| 87340 |
|
433 |
427 |
$4K |
| 73130 |
|
173 |
168 |
$4K |
| 86901 |
|
461 |
422 |
$4K |
| 74176 |
|
165 |
161 |
$4K |
| 74022 |
|
469 |
445 |
$4K |
| 90715 |
|
96 |
96 |
$4K |
| 59025 |
|
183 |
91 |
$4K |
| 83735 |
|
1,078 |
952 |
$4K |
| 87186 |
|
641 |
621 |
$4K |
| 82607 |
|
380 |
378 |
$4K |
| 81025 |
|
602 |
581 |
$3K |
| 84403 |
|
161 |
154 |
$3K |
| 93225 |
|
117 |
116 |
$3K |
| J1170 |
Hydromorphone injection |
172 |
150 |
$3K |
| 83880 |
|
528 |
497 |
$3K |
| 86140 |
|
840 |
754 |
$3K |
| 72100 |
|
223 |
222 |
$3K |
| 95816 |
|
122 |
105 |
$3K |
| 76801 |
|
128 |
124 |
$3K |
| 86038 |
|
333 |
327 |
$3K |
| 82746 |
|
239 |
239 |
$3K |
| 94729 |
|
224 |
142 |
$3K |
| 73502 |
|
158 |
152 |
$3K |
| 94726 |
|
218 |
140 |
$3K |
| 86762 |
|
236 |
234 |
$3K |
| 83690 |
|
1,360 |
1,249 |
$3K |
| 76642 |
|
68 |
63 |
$3K |
| 87880 |
|
605 |
594 |
$3K |
| 95911 |
|
33 |
31 |
$3K |
| Z7502 |
|
75 |
73 |
$3K |
| 80048 |
|
439 |
413 |
$3K |
| 71260 |
|
13 |
13 |
$3K |
| 85610 |
|
1,154 |
1,079 |
$3K |
| 81003 |
|
1,206 |
1,162 |
$3K |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
543 |
530 |
$3K |
| 94640 |
|
458 |
426 |
$2K |
| 99214 |
|
137 |
130 |
$2K |
| 72125 |
|
73 |
70 |
$2K |
| 99212 |
|
164 |
158 |
$2K |
| 82107 |
|
44 |
42 |
$2K |
| J0780 |
Prochlorperazine injection |
74 |
68 |
$2K |
| 86900 |
|
426 |
390 |
$2K |
| 94375 |
|
249 |
158 |
$2K |
| 87077 |
|
638 |
613 |
$2K |
| 72072 |
|
69 |
68 |
$2K |
| 82043 |
|
423 |
419 |
$2K |
| 77065 |
Tomosynthesis, mammo |
25 |
25 |
$2K |
| 82274 |
|
219 |
211 |
$2K |
| 82805 |
|
91 |
87 |
$2K |
| 70486 |
|
26 |
26 |
$2K |
| 83540 |
|
316 |
310 |
$2K |
| 84100 |
|
467 |
410 |
$2K |
| 72040 |
|
104 |
104 |
$2K |
| 74018 |
|
120 |
116 |
$2K |
| 86850 |
|
391 |
358 |
$2K |
| 86592 |
|
400 |
391 |
$2K |
| 87641 |
|
100 |
98 |
$2K |
| 80074 |
|
42 |
42 |
$2K |
| 85652 |
|
716 |
662 |
$2K |
| 96367 |
|
27 |
24 |
$1K |
| 97110 |
|
1,216 |
391 |
$1K |
| 99204 |
|
19 |
19 |
$1K |
| 83550 |
|
210 |
207 |
$1K |
| 84550 |
|
452 |
429 |
$1K |
| 94200 |
|
232 |
148 |
$1K |
| 73080 |
|
46 |
43 |
$1K |
| 85730 |
|
539 |
523 |
$1K |
| 83605 |
|
825 |
758 |
$1K |
| 0250 |
|
612 |
508 |
$1K |
| 76705 |
|
52 |
51 |
$1K |
| 87040 |
|
598 |
494 |
$1K |
| J7120 |
Ringers lactate infusion |
186 |
172 |
$1K |
| Z7500 |
|
36 |
28 |
$1K |
| 83516 |
|
114 |
93 |
$1K |
| 82150 |
|
409 |
397 |
$1K |
| 93017 |
|
27 |
27 |
$1K |
| 76770 |
|
38 |
36 |
$1K |
| 74019 |
|
107 |
107 |
$1K |
| 83520 |
|
32 |
28 |
$1K |
| 84702 |
|
217 |
188 |
$1K |
| 45385 |
|
17 |
13 |
$1K |
| 92557 |
|
28 |
26 |
$1K |
| J7040 |
Normal saline solution infus |
75 |
72 |
$1K |
| J3010 |
Fentanyl citrate injection |
174 |
157 |
$997.87 |
| 71045 |
|
424 |
403 |
$935.23 |
| 36415 |
|
164 |
154 |
$919.54 |
| 85007 |
|
333 |
261 |
$815.97 |
| 86430 |
|
171 |
170 |
$798.08 |
| 86480 |
|
15 |
15 |
$722.19 |
| 93016 |
|
58 |
58 |
$699.59 |
| 82950 |
|
140 |
140 |
$662.05 |
| 95909 |
|
14 |
12 |
$660.60 |
| 76536 |
|
21 |
20 |
$624.59 |
| 87045 |
|
94 |
93 |
$622.71 |
| J2250 |
Inj midazolam hydrochloride |
93 |
89 |
$596.72 |
| 80076 |
|
105 |
103 |
$587.85 |
| 82550 |
|
339 |
312 |
$567.89 |
| 87493 |
|
51 |
51 |
$549.37 |
| 82553 |
|
257 |
247 |
$521.79 |
| 76813 |
|
13 |
12 |
$519.95 |
| 82248 |
|
107 |
106 |
$507.39 |
| 71020 |
|
21 |
19 |
$494.28 |
| 87328 |
|
58 |
57 |
$475.59 |
| 82951 |
|
26 |
25 |
$471.69 |
| 87205 |
|
219 |
215 |
$470.29 |
| 97140 |
|
403 |
160 |
$470.10 |
| 84703 |
|
269 |
261 |
$460.16 |
| J7050 |
Normal saline solution infus |
42 |
32 |
$441.63 |
| 93018 |
|
58 |
58 |
$435.27 |
| 86317 |
|
35 |
34 |
$425.78 |
| 73523 |
|
13 |
13 |
$406.54 |
| 87427 |
|
79 |
79 |
$393.18 |
| 82785 |
|
26 |
25 |
$368.93 |
| 85379 |
|
141 |
138 |
$357.80 |
| 83615 |
|
81 |
68 |
$341.90 |
| 87899 |
|
81 |
81 |
$327.54 |
| 36600 |
|
49 |
48 |
$312.19 |
| 73140 |
|
12 |
12 |
$287.27 |
| 80178 |
|
17 |
13 |
$266.48 |
| 87329 |
|
45 |
45 |
$252.69 |
| 82948 |
|
128 |
103 |
$247.32 |
| 82977 |
|
35 |
34 |
$242.54 |
| 83883 |
|
14 |
14 |
$230.53 |
| 82784 |
|
26 |
25 |
$228.36 |
| 99232 |
|
17 |
13 |
$223.02 |
| J2550 |
Promethazine hcl injection |
60 |
55 |
$219.08 |
| G0279 |
Tomosynthesis, mammo |
32 |
31 |
$204.00 |
| 73560 |
|
14 |
14 |
$202.40 |
| 86704 |
|
24 |
24 |
$196.27 |
| J2765 |
Metoclopramide hcl injection |
43 |
40 |
$187.69 |
| 83001 |
|
14 |
14 |
$186.39 |
| 86141 |
|
25 |
25 |
$177.29 |
| 90686 |
|
13 |
13 |
$175.29 |
| 86800 |
|
15 |
14 |
$169.32 |
| 84146 |
|
12 |
12 |
$151.20 |
| S0020 |
Injection, bupivicaine hydro |
13 |
13 |
$132.62 |
| 86780 |
|
13 |
13 |
$132.57 |
| 86376 |
|
13 |
13 |
$129.70 |
| 99285 |
|
13 |
13 |
$121.53 |
| 86200 |
|
30 |
30 |
$121.00 |
| 86308 |
|
63 |
61 |
$120.36 |
| 86039 |
|
12 |
12 |
$99.35 |
| 0259 |
|
21 |
18 |
$87.76 |
| 83525 |
|
12 |
12 |
$81.51 |
| 86431 |
|
14 |
14 |
$50.30 |
| 99284 |
|
28 |
26 |
$49.60 |
| 82947 |
|
14 |
14 |
$45.57 |
| 0510 |
|
308 |
261 |
$38.53 |
| 87503 |
|
18 |
18 |
$38.34 |
| 84156 |
|
20 |
15 |
$14.35 |
| 0302 |
|
70 |
69 |
$0.00 |
| 0300 |
|
432 |
370 |
$0.00 |
| 0320 |
|
26 |
26 |
$0.00 |
| 0730 |
|
77 |
72 |
$0.00 |
| 0489 |
|
18 |
18 |
$0.00 |
| 0471 |
|
232 |
228 |
$0.00 |
| 0324 |
|
143 |
139 |
$0.00 |
| 0258 |
|
274 |
263 |
$0.00 |
| 0259R |
|
32 |
24 |
$0.00 |
| 0301 |
|
438 |
399 |
$0.00 |
| 0305 |
|
372 |
335 |
$0.00 |
| G0463 |
Hospital outpt clinic visit |
466 |
441 |
$0.00 |
| 0306 |
|
243 |
232 |
$0.00 |
| G0283 |
Elec stim other than wound |
92 |
26 |
$0.00 |
| 97139 |
|
649 |
149 |
$0.00 |
| 0410 |
|
19 |
17 |
$0.00 |
| 0721 |
|
52 |
51 |
$0.00 |
| 97010 |
|
70 |
29 |
$0.00 |
| 0307 |
|
85 |
85 |
$0.00 |
| J1626 |
Granisetron hcl injection |
17 |
16 |
$0.00 |
| 97750 |
|
56 |
53 |
$0.00 |
| 0720 |
|
57 |
55 |
$0.00 |
| 0420 |
|
13 |
12 |
$0.00 |