| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 0450 |
|
254,320 |
227,868 |
$8.67M |
| 99199 |
|
44,886 |
39,010 |
$7.68M |
| T1999 |
Noc retail items andsupplies |
21,687 |
13,205 |
$2.35M |
| 80053 |
|
209,304 |
191,600 |
$2.02M |
| 96372 |
|
46,710 |
43,384 |
$1.11M |
| U0003 |
Cov-19 amp prb hgh thruput |
27,837 |
26,937 |
$1.01M |
| 0360 |
|
15,303 |
13,603 |
$969K |
| Z7502 |
|
21,120 |
20,725 |
$769K |
| 80306 |
|
37,291 |
35,140 |
$511K |
| J1745 |
Infliximab not biosimil 10mg |
477 |
449 |
$404K |
| 96361 |
|
23,975 |
22,225 |
$403K |
| J2405 |
Ondansetron hcl injection |
26,957 |
24,618 |
$382K |
| 87635 |
|
13,964 |
13,594 |
$349K |
| G0480 |
Drug test def 1-7 classes |
13,871 |
12,327 |
$336K |
| S0119 |
Ondansetron 4 mg |
10,975 |
10,684 |
$314K |
| 71046 |
|
68,947 |
61,505 |
$314K |
| J7030 |
Normal saline solution infus |
12,135 |
11,319 |
$293K |
| J3490 |
Drugs unclassified injection |
69,824 |
45,304 |
$281K |
| 81001 |
|
147,168 |
136,535 |
$280K |
| 96374 |
|
37,792 |
34,681 |
$275K |
| J0696 |
Ceftriaxone sodium injection |
16,971 |
15,985 |
$267K |
| 87637 |
|
10,761 |
10,479 |
$244K |
| J1885 |
Ketorolac tromethamine inj |
36,626 |
34,645 |
$233K |
| 85025 |
|
222,303 |
201,914 |
$218K |
| 71045 |
|
81,970 |
65,488 |
$194K |
| Q5103 |
Injection, inflectra |
898 |
774 |
$189K |
| 70450 |
|
24,298 |
21,701 |
$187K |
| 99070 |
|
58,440 |
34,923 |
$174K |
| 74177 |
|
20,918 |
18,320 |
$172K |
| 93005 |
|
68,153 |
62,357 |
$165K |
| 87086 |
|
54,077 |
51,398 |
$157K |
| J1100 |
Dexamethasone sodium phos |
11,147 |
10,799 |
$157K |
| J7120 |
Ringers lactate infusion |
7,781 |
7,264 |
$150K |
| 96360 |
|
7,978 |
7,785 |
$146K |
| 0250 |
|
19,157 |
16,021 |
$139K |
| 74176 |
|
16,635 |
14,624 |
$137K |
| 0270 |
|
103,943 |
59,793 |
$124K |
| 86850 |
|
9,417 |
9,001 |
$120K |
| 73130 |
|
11,020 |
9,943 |
$120K |
| 73610 |
|
10,534 |
9,398 |
$119K |
| 87502 |
|
28,085 |
27,404 |
$118K |
| 73562 |
|
13,198 |
11,769 |
$113K |
| 73630 |
|
15,286 |
13,831 |
$112K |
| 99283 |
|
14,771 |
14,141 |
$110K |
| 81025 |
|
44,128 |
42,178 |
$109K |
| 87651 |
|
9,364 |
9,297 |
$106K |
| 96365 |
|
7,530 |
6,686 |
$100K |
| 87491 |
|
16,336 |
15,902 |
$97K |
| 86900 |
|
13,945 |
13,100 |
$96K |
| 80048 |
|
16,682 |
15,533 |
$92K |
| 73030 |
|
11,605 |
10,378 |
$92K |
| 86901 |
|
13,954 |
13,108 |
$91K |
| 70553 |
|
1,272 |
1,160 |
$88K |
| 45378 |
|
3,608 |
3,545 |
$83K |
| 0710 |
|
8,186 |
7,931 |
$81K |
| J2270 |
Morphine sulfate injection |
15,689 |
13,848 |
$79K |
| 84443 |
|
52,077 |
51,230 |
$73K |
| 84702 |
|
12,657 |
10,360 |
$72K |
| 99284 |
|
13,155 |
12,416 |
$71K |
| J2930 |
Methylprednisolone injection |
3,919 |
3,669 |
$70K |
| 80143 |
|
3,287 |
2,970 |
$69K |
| 76700 |
|
18,424 |
16,517 |
$68K |
| 82306 |
|
31,471 |
31,170 |
$67K |
| 74018 |
|
10,944 |
9,660 |
$64K |
| 82962 |
|
9,051 |
6,929 |
$62K |
| 76805 |
|
12,970 |
11,221 |
$61K |
| 80061 |
|
48,533 |
48,122 |
$59K |
| 90715 |
|
4,513 |
4,492 |
$58K |
| 77067 |
|
27,917 |
24,539 |
$57K |
| 87081 |
|
8,015 |
7,894 |
$57K |
| J2765 |
Metoclopramide hcl injection |
6,046 |
5,761 |
$55K |
| 97530 |
|
34,722 |
11,312 |
$55K |
| J2360 |
Orphenadrine injection |
1,000 |
970 |
$54K |
| 99282 |
|
3,168 |
2,972 |
$54K |
| 96375 |
|
27,184 |
24,640 |
$53K |
| J2704 |
Inj, propofol, 10 mg |
11,809 |
11,480 |
$53K |
| 73110 |
|
5,316 |
4,775 |
$53K |
| J1200 |
Diphenhydramine hcl injectio |
10,924 |
10,093 |
$52K |
| 87186 |
|
14,507 |
13,960 |
$51K |
| 83880 |
|
17,743 |
16,544 |
$50K |
| 73721 |
|
2,745 |
2,436 |
$49K |
| 76705 |
|
16,434 |
14,315 |
$48K |
| 83036 |
|
45,973 |
45,428 |
$46K |
| 87591 |
|
16,154 |
15,726 |
$44K |
| 0259 |
|
3,570 |
2,564 |
$42K |
| 76856 |
|
19,512 |
17,096 |
$40K |
| 99285 |
|
6,534 |
6,148 |
$40K |
| 43239 |
|
3,134 |
3,046 |
$40K |
| 72100 |
|
7,497 |
6,660 |
$39K |
| 70486 |
|
2,671 |
2,335 |
$39K |
| J3010 |
Fentanyl citrate injection |
13,537 |
12,715 |
$39K |
| 93010 |
|
21,890 |
19,405 |
$38K |
| 73080 |
|
3,076 |
2,727 |
$37K |
| 76770 |
|
8,157 |
7,259 |
$37K |
| J2060 |
Lorazepam injection |
3,903 |
3,426 |
$36K |
| 72148 |
|
2,807 |
2,532 |
$35K |
| J1170 |
Hydromorphone injection |
6,188 |
5,283 |
$35K |
| 99281 |
|
24,181 |
20,665 |
$35K |
| 73221 |
|
1,353 |
1,213 |
$33K |
| 87389 |
|
16,139 |
15,970 |
$33K |
| 70551 |
|
1,543 |
1,366 |
$33K |
| 72040 |
|
3,434 |
3,040 |
$32K |
| 76801 |
|
12,590 |
9,756 |
$32K |
| 76830 |
|
14,661 |
12,800 |
$32K |
| 71250 |
|
3,272 |
2,934 |
$31K |
| J0561 |
Penicillin g benzathine inj |
593 |
588 |
$30K |
| 76536 |
|
6,648 |
5,857 |
$29K |
| J2550 |
Promethazine hcl injection |
2,026 |
1,944 |
$27K |
| J1815 |
Insulin injection |
3,352 |
2,323 |
$26K |
| 94640 |
|
11,504 |
10,024 |
$26K |
| 77066 |
Tomosynthesis, mammo |
5,649 |
4,878 |
$26K |
| 76642 |
|
10,213 |
8,873 |
$26K |
| 71101 |
|
1,564 |
1,365 |
$26K |
| J0780 |
Prochlorperazine injection |
1,029 |
993 |
$25K |
| 84484 |
|
41,081 |
35,743 |
$25K |
| 95810 |
|
1,135 |
1,119 |
$24K |
| J2250 |
Inj midazolam hydrochloride |
9,795 |
9,347 |
$24K |
| 73590 |
|
2,570 |
2,260 |
$24K |
| 73090 |
|
2,284 |
2,012 |
$23K |
| 72125 |
|
3,838 |
3,353 |
$23K |
| 86780 |
|
14,174 |
13,639 |
$23K |
| 87077 |
|
16,056 |
15,387 |
$20K |
| 74178 |
|
753 |
659 |
$20K |
| 97110 |
|
25,407 |
9,210 |
$20K |
| 73502 |
|
3,318 |
2,965 |
$20K |
| 92507 |
|
5,236 |
1,888 |
$20K |
| J1630 |
Haloperidol injection |
1,867 |
1,591 |
$20K |
| 83690 |
|
54,275 |
50,877 |
$20K |
| 0324 |
|
1,381 |
1,325 |
$20K |
| 0762 |
|
767 |
284 |
$19K |
| J7040 |
Normal saline solution infus |
881 |
843 |
$19K |
| 87070 |
|
3,213 |
3,138 |
$18K |
| 87798 |
|
23,249 |
22,628 |
$18K |
| 76819 |
|
4,537 |
3,117 |
$17K |
| 71275 |
|
2,870 |
2,471 |
$17K |
| 72131 |
|
1,844 |
1,601 |
$16K |
| 80074 |
|
3,615 |
3,526 |
$16K |
| 12001 |
|
602 |
602 |
$16K |
| 74019 |
|
3,601 |
3,186 |
$16K |
| 0121 |
|
437 |
399 |
$15K |
| 73620 |
|
1,585 |
1,378 |
$15K |
| S0077 |
Injection, clindamycin phosp |
1,141 |
927 |
$15K |
| 71260 |
|
2,379 |
2,140 |
$15K |
| 95811 |
|
907 |
898 |
$15K |
| 80307 |
|
1,005 |
965 |
$15K |
| 76870 |
|
2,682 |
2,250 |
$14K |
| 86920 |
|
875 |
771 |
$14K |
| 59025 |
|
11,085 |
6,302 |
$14K |
| 97140 |
|
11,594 |
4,442 |
$14K |
| 73120 |
|
966 |
861 |
$14K |
| 77065 |
Tomosynthesis, mammo |
2,972 |
2,556 |
$14K |
| J1940 |
Furosemide injection |
1,042 |
829 |
$13K |
| 73560 |
|
1,924 |
1,684 |
$13K |
| 72141 |
|
430 |
404 |
$13K |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
18,624 |
17,960 |
$13K |
| 76817 |
|
5,024 |
3,807 |
$13K |
| 85730 |
|
11,298 |
10,725 |
$12K |
| A9579 |
Gad-base mr contrast nos,1ml |
1,685 |
1,653 |
$12K |
| J0131 |
Inj, acetaminophen (nos) |
1,179 |
1,157 |
$12K |
| 93971 |
|
4,484 |
3,891 |
$11K |
| 84439 |
|
17,337 |
17,060 |
$11K |
| 85610 |
|
24,178 |
22,466 |
$11K |
| 93306 |
|
560 |
559 |
$11K |
| 72070 |
|
2,004 |
1,835 |
$11K |
| 45380 |
|
322 |
319 |
$11K |
| 0403 |
|
207 |
207 |
$11K |
| Z7610 |
|
8,765 |
5,272 |
$11K |
| 73564 |
|
3,064 |
2,843 |
$10K |
| J1720 |
Hydrocortisone sodium succ i |
1,104 |
986 |
$10K |
| J7050 |
Normal saline solution infus |
2,735 |
2,356 |
$10K |
| 86803 |
|
7,264 |
7,206 |
$10K |
| 82607 |
|
12,615 |
12,479 |
$10K |
| J0690 |
Cefazolin sodium injection |
2,835 |
2,573 |
$10K |
| S0020 |
Injection, bupivicaine hydro |
1,820 |
1,742 |
$10K |
| U0002 |
Covid-19 lab test non-cdc |
107 |
107 |
$10K |
| 82274 |
|
3,393 |
3,363 |
$9K |
| 0760 |
|
2,453 |
1,760 |
$9K |
| 96413 |
|
1,814 |
1,617 |
$8K |
| 83013 |
|
1,865 |
1,860 |
$8K |
| 0300 |
|
1,418 |
1,241 |
$8K |
| 82043 |
|
14,416 |
14,221 |
$8K |
| 84153 |
|
3,700 |
3,649 |
$8K |
| 87807 |
|
1,178 |
1,147 |
$8K |
| 84703 |
|
10,254 |
9,992 |
$8K |
| 77063 |
|
10,532 |
9,428 |
$8K |
| 86003 |
|
734 |
454 |
$8K |
| 73600 |
|
545 |
482 |
$8K |
| 36415 |
|
7,561 |
6,676 |
$7K |
| 97112 |
|
7,592 |
2,608 |
$7K |
| 12002 |
|
375 |
375 |
$7K |
| 87040 |
|
14,212 |
7,906 |
$7K |
| C1776 |
Joint device (implantable) |
13 |
13 |
$7K |
| 86481 |
|
1,804 |
1,785 |
$7K |
| 83655 |
|
8,959 |
8,813 |
$7K |
| 82805 |
|
2,224 |
2,072 |
$7K |
| 72110 |
|
4,308 |
3,968 |
$7K |
| G0279 |
Tomosynthesis, mammo |
4,376 |
3,869 |
$6K |
| 84145 |
|
955 |
930 |
$6K |
| 88305 |
|
467 |
446 |
$6K |
| 84481 |
|
6,334 |
6,248 |
$6K |
| 47562 |
|
58 |
54 |
$6K |
| 96415 |
|
1,747 |
1,558 |
$6K |
| 73060 |
|
465 |
407 |
$6K |
| P9016 |
Rbc leukocytes reduced |
758 |
639 |
$6K |
| 97750 |
|
3,200 |
1,881 |
$5K |
| 76857 |
|
3,590 |
3,034 |
$5K |
| 72170 |
|
810 |
736 |
$5K |
| 70360 |
|
307 |
267 |
$5K |
| 93970 |
|
1,080 |
932 |
$5K |
| 87340 |
|
6,003 |
5,925 |
$5K |
| 80076 |
|
3,218 |
3,157 |
$5K |
| 86762 |
|
4,628 |
4,183 |
$5K |
| C9803 |
Hopd covid-19 spec collect |
669 |
611 |
$5K |
| 86635 |
|
3,509 |
1,963 |
$5K |
| 87880 |
|
2,344 |
2,275 |
$5K |
| 78815 |
|
136 |
131 |
$5K |
| 70491 |
|
469 |
407 |
$5K |
| 82105 |
|
732 |
724 |
$5K |
| 84403 |
|
2,236 |
2,130 |
$4K |
| 86694 |
|
1,758 |
1,415 |
$4K |
| 84550 |
|
5,643 |
5,464 |
$4K |
| 83001 |
|
2,373 |
2,353 |
$4K |
| 74022 |
|
569 |
493 |
$4K |
| 86038 |
|
3,949 |
3,891 |
$4K |
| 77080 |
|
2,278 |
1,959 |
$4K |
| 84146 |
|
2,012 |
1,992 |
$4K |
| 12011 |
|
196 |
195 |
$4K |
| 29125 |
|
327 |
315 |
$4K |
| 83605 |
|
12,532 |
10,458 |
$4K |
| 83735 |
|
17,499 |
16,329 |
$3K |
| 80305 |
|
448 |
443 |
$3K |
| 86480 |
|
591 |
581 |
$3K |
| 73552 |
|
428 |
378 |
$3K |
| 0401 |
|
35 |
35 |
$3K |
| 85027 |
|
5,325 |
5,261 |
$3K |
| 0160 |
|
819 |
326 |
$3K |
| 83970 |
|
1,677 |
1,645 |
$3K |
| 97010 |
|
7,390 |
2,971 |
$3K |
| 82728 |
|
4,440 |
4,354 |
$3K |
| 0320 |
|
168 |
160 |
$3K |
| U0005 |
Infec agen detec ampli probe |
19,786 |
19,185 |
$3K |
| 87045 |
|
654 |
640 |
$3K |
| 96366 |
|
1,489 |
1,214 |
$3K |
| 81220 |
|
157 |
156 |
$3K |
| 86141 |
|
3,281 |
3,212 |
$3K |
| 82746 |
|
3,950 |
3,902 |
$3K |
| J7512 |
Prednisone ir or dr oral 1mg |
952 |
927 |
$3K |
| 83002 |
|
1,742 |
1,722 |
$3K |
| 97014 |
|
6,547 |
2,580 |
$3K |
| J3370 |
Vancomycin hcl injection |
389 |
283 |
$3K |
| 87210 |
|
2,296 |
2,231 |
$3K |
| J3475 |
Inj magnesium sulfate |
1,218 |
1,087 |
$3K |
| 76981 |
|
211 |
205 |
$2K |
| 97163 |
|
1,585 |
1,577 |
$2K |
| 10060 |
|
167 |
162 |
$2K |
| 86787 |
|
2,266 |
1,874 |
$2K |
| 84436 |
|
3,394 |
3,372 |
$2K |
| 73100 |
|
283 |
263 |
$2K |
| 97016 |
|
3,640 |
1,254 |
$2K |
| 72050 |
|
1,251 |
1,181 |
$2K |
| 80179 |
|
3,160 |
2,895 |
$2K |
| 86140 |
|
5,418 |
5,288 |
$2K |
| J3260 |
Tobramycin sulfate injection |
502 |
494 |
$2K |
| 73700 |
|
213 |
181 |
$2K |
| 86235 |
|
971 |
736 |
$2K |
| 49083 |
|
102 |
64 |
$2K |
| 86696 |
|
1,086 |
1,077 |
$2K |
| 70496 |
|
448 |
405 |
$2K |
| J2710 |
Neostigmine methylslfte inj |
565 |
522 |
$2K |
| 84466 |
|
2,924 |
2,867 |
$2K |
| 45385 |
|
68 |
67 |
$2K |
| 94060 |
|
373 |
370 |
$2K |
| 82248 |
|
2,236 |
2,064 |
$2K |
| 83516 |
|
2,407 |
1,665 |
$2K |
| 82553 |
|
2,119 |
1,984 |
$2K |
| 86317 |
|
1,383 |
1,357 |
$2K |
| 74181 |
|
47 |
41 |
$2K |
| J0558 |
Peng benzathine/procaine inj |
13 |
13 |
$2K |
| 80069 |
|
1,844 |
1,773 |
$2K |
| J2795 |
Ropivacaine hcl injection |
198 |
192 |
$2K |
| 83540 |
|
4,251 |
4,177 |
$1K |
| 76000 |
|
561 |
552 |
$1K |
| 99152 |
|
124 |
123 |
$1K |
| 86376 |
|
1,392 |
1,377 |
$1K |
| 85652 |
|
7,962 |
7,775 |
$1K |
| 78227 |
|
28 |
24 |
$1K |
| 82670 |
|
774 |
763 |
$1K |
| 82950 |
|
3,882 |
3,859 |
$1K |
| 86039 |
|
1,442 |
1,422 |
$1K |
| 99291 |
|
243 |
240 |
$1K |
| 87400 |
|
229 |
159 |
$1K |
| 86160 |
|
1,979 |
1,488 |
$1K |
| 73140 |
|
92 |
82 |
$1K |
| 76815 |
|
679 |
598 |
$1K |
| 82247 |
|
269 |
243 |
$1K |
| 82570 |
|
3,956 |
3,735 |
$1K |
| 76811 |
|
223 |
196 |
$1K |
| 82533 |
|
837 |
816 |
$1K |
| A9552 |
F18 fdg |
50 |
50 |
$1K |
| J1956 |
Levofloxacin injection |
12 |
12 |
$1K |
| 92523 |
|
100 |
99 |
$1K |
| 82550 |
|
4,032 |
3,839 |
$1K |
| J0360 |
Hydralazine hcl injection |
599 |
540 |
$1K |
| 71020 |
|
562 |
340 |
$1K |
| 84154 |
|
410 |
407 |
$997.38 |
| 97139 |
|
5,650 |
1,491 |
$994.23 |
| 72128 |
|
89 |
83 |
$956.23 |
| 29515 |
|
61 |
59 |
$931.67 |
| 78264 |
|
37 |
37 |
$930.12 |
| 88112 |
|
138 |
135 |
$920.72 |
| J0500 |
Dicyclomine injection |
53 |
53 |
$890.40 |
| 83014 |
|
1,415 |
1,411 |
$888.94 |
| 84270 |
|
731 |
708 |
$873.51 |
| 82010 |
|
2,483 |
2,293 |
$862.47 |
| 82785 |
|
556 |
531 |
$860.20 |
| 80320 |
|
637 |
581 |
$825.50 |
| J2300 |
Inj nalbuphine hydrochloride |
16 |
16 |
$818.22 |
| 86225 |
|
1,293 |
1,285 |
$802.17 |
| 70498 |
|
456 |
412 |
$790.18 |
| 84100 |
|
3,702 |
3,438 |
$778.12 |
| 94664 |
|
1,636 |
1,492 |
$726.08 |
| 84480 |
|
733 |
719 |
$718.39 |
| 85379 |
|
2,914 |
2,846 |
$718.14 |
| J1953 |
Levetiracetam injection |
494 |
450 |
$707.45 |
| 82951 |
|
1,047 |
1,020 |
$705.99 |
| 84445 |
|
66 |
66 |
$699.00 |
| J0665 |
Inj, bupivacaine, nos, 0.5mg |
458 |
450 |
$696.46 |
| 87338 |
|
794 |
788 |
$685.20 |
| 99213 |
|
32,542 |
27,479 |
$671.43 |
| 29130 |
|
28 |
28 |
$663.84 |
| 87522 |
Neg quan hep c or qual rna |
297 |
290 |
$654.68 |
| 84144 |
|
446 |
436 |
$641.85 |
| 36600 |
|
138 |
127 |
$641.14 |
| 86171 |
|
503 |
465 |
$628.75 |
| 87205 |
|
1,565 |
1,515 |
$620.25 |
| 86800 |
|
722 |
649 |
$617.15 |
| 87220 |
|
767 |
754 |
$608.12 |
| J2003 |
Inj, lidocaine hcl, 1 mg |
357 |
332 |
$599.35 |
| 97161 |
|
542 |
511 |
$594.25 |
| 86431 |
|
1,785 |
1,736 |
$592.96 |
| 87150 |
|
139 |
98 |
$578.61 |
| 82977 |
|
862 |
811 |
$556.21 |
| J7510 |
Prednisolone oral per 5 mg |
331 |
327 |
$542.23 |
| 73000 |
|
32 |
24 |
$531.00 |
| 87209 |
|
156 |
146 |
$529.30 |
| 97018 |
|
2,668 |
902 |
$527.62 |
| J7999 |
Compounded drug, noc |
15 |
15 |
$521.04 |
| 84402 |
|
278 |
269 |
$500.92 |
| 73522 |
|
152 |
138 |
$495.58 |
| 42821 |
|
15 |
12 |
$493.74 |
| 84156 |
|
2,607 |
2,265 |
$487.09 |
| 82140 |
|
1,406 |
1,319 |
$468.53 |
| 86430 |
|
762 |
753 |
$451.20 |
| 27447 |
|
12 |
12 |
$448.60 |
| 0510 |
|
503 |
397 |
$437.33 |
| 93017 |
|
48 |
48 |
$428.93 |
| 0301 |
|
856 |
799 |
$419.22 |
| 76816 |
|
111 |
106 |
$414.78 |
| 84479 |
|
1,594 |
1,588 |
$411.54 |
| 94729 |
|
133 |
133 |
$380.87 |
| 84630 |
|
858 |
846 |
$357.35 |
| J0736 |
Inj, clindamycin phosp 300mg |
48 |
44 |
$354.80 |
| 71010 |
|
149 |
71 |
$323.96 |
| 86308 |
|
135 |
134 |
$318.95 |
| 82150 |
|
432 |
404 |
$316.28 |
| 0729 |
|
916 |
713 |
$316.12 |
| J1644 |
Inj heparin sodium per 1000u |
254 |
162 |
$315.52 |
| 94726 |
|
104 |
104 |
$314.76 |
| 86147 |
|
97 |
80 |
$314.66 |
| J8597 |
Antiemetic drug oral nos |
84 |
78 |
$313.00 |
| 82947 |
|
1,126 |
1,108 |
$312.59 |
| 32555 |
|
44 |
40 |
$308.55 |
| 97167 |
|
120 |
120 |
$304.65 |
| 82627 |
|
174 |
172 |
$299.10 |
| 88304 |
|
16 |
14 |
$294.24 |
| 86200 |
|
510 |
502 |
$278.13 |
| 74220 |
|
47 |
42 |
$276.13 |
| 83615 |
|
542 |
510 |
$268.34 |
| 77049 |
|
12 |
12 |
$264.54 |
| 86704 |
|
299 |
297 |
$253.91 |
| 82390 |
|
607 |
601 |
$252.81 |
| A9541 |
Tc99m sulfur colloid |
25 |
25 |
$236.01 |
| 90471 |
|
3,429 |
3,358 |
$234.34 |
| J1580 |
Garamycin gentamicin inj |
67 |
63 |
$232.15 |
| 84460 |
|
1,019 |
1,010 |
$214.73 |
| J2919 |
Inj, methylpred sod succ 5mg |
592 |
575 |
$211.67 |
| 85576 |
|
42 |
40 |
$202.01 |
| J8540 |
Oral dexamethasone |
454 |
441 |
$188.24 |
| 86015 |
|
155 |
154 |
$184.48 |
| G0463 |
Hospital outpt clinic visit |
13 |
13 |
$178.94 |
| 84425 |
|
266 |
264 |
$170.37 |
| J0737 |
Inj, clindamycin (baxter) |
32 |
26 |
$157.54 |
| 87536 |
|
66 |
66 |
$151.97 |
| 82107 |
|
17 |
17 |
$140.24 |
| 83951 |
|
17 |
17 |
$140.24 |
| 83090 |
|
329 |
325 |
$136.86 |
| 0352 |
|
103 |
95 |
$132.36 |
| 74000 |
|
49 |
36 |
$131.21 |
| 96367 |
|
135 |
133 |
$125.77 |
| A9575 |
Inj gadoterate meglumi 0.1ml |
207 |
198 |
$123.37 |
| 83498 |
|
12 |
12 |
$119.65 |
| 97165 |
|
96 |
95 |
$119.52 |
| 84450 |
|
590 |
586 |
$113.73 |
| 99214 |
|
3,128 |
2,916 |
$112.13 |
| 89055 |
|
158 |
157 |
$111.32 |
| 87177 |
|
156 |
147 |
$103.48 |
| 0350 |
|
26 |
25 |
$103.45 |
| A4595 |
Tens suppl 2 lead per month |
630 |
468 |
$101.61 |
| J0702 |
Betamethasone acet&sod phosp |
18 |
12 |
$97.50 |
| J1171 |
Inj, hydromorphone, 0.1 mg |
82 |
64 |
$95.00 |
| 87147 |
|
415 |
410 |
$92.98 |
| 97162 |
|
793 |
406 |
$92.26 |
| 86592 |
|
232 |
225 |
$87.24 |
| 82784 |
|
144 |
126 |
$85.12 |
| 84432 |
|
30 |
28 |
$84.93 |
| 81003 |
|
1,675 |
1,522 |
$81.86 |
| 87899 |
|
116 |
75 |
$78.81 |
| 74174 |
|
30 |
27 |
$73.80 |
| 86765 |
|
42 |
42 |
$72.69 |
| 99221 |
|
730 |
585 |
$71.31 |
| 82310 |
|
265 |
248 |
$67.40 |
| 72114 |
|
43 |
43 |
$64.61 |
| 72220 |
|
153 |
142 |
$63.43 |
| G0328 |
Fecal blood scrn immunoassay |
742 |
733 |
$62.06 |
| 82952 |
|
406 |
400 |
$61.69 |
| T1015 |
Clinic service |
2,210 |
1,965 |
$60.89 |
| 0730 |
|
444 |
409 |
$59.68 |
| 94760 |
|
126 |
92 |
$57.08 |
| 86300 |
|
13 |
12 |
$56.76 |
| 92650 |
|
156 |
151 |
$56.50 |
| 87510 |
|
55 |
54 |
$54.15 |
| 87480 |
|
55 |
54 |
$54.09 |
| 72072 |
|
16 |
16 |
$48.84 |
| 0636 |
|
521 |
499 |
$48.10 |
| J0171 |
Adrenalin epinephrine inject |
42 |
39 |
$47.06 |
| 93880 |
|
25 |
24 |
$45.32 |
| 73070 |
|
90 |
78 |
$44.48 |
| 84132 |
|
79 |
76 |
$41.40 |
| 85613 |
|
26 |
25 |
$40.90 |
| 76881 |
|
14 |
13 |
$39.97 |
| 97116 |
|
35 |
12 |
$39.90 |
| 74330 |
|
13 |
12 |
$39.61 |
| 85045 |
|
385 |
377 |
$37.59 |
| J3360 |
Diazepam injection |
175 |
167 |
$35.72 |
| 87046 |
|
55 |
55 |
$34.12 |
| 82652 |
|
133 |
132 |
$33.18 |
| 84590 |
|
86 |
82 |
$32.42 |
| 74240 |
|
14 |
14 |
$26.63 |
| 0761 |
|
67 |
64 |
$23.77 |
| 86364 |
|
15 |
14 |
$23.53 |
| 0305 |
|
881 |
834 |
$22.63 |
| 0306 |
|
667 |
626 |
$21.05 |
| 86334 |
|
14 |
13 |
$20.03 |
| 10005 |
|
12 |
12 |
$19.80 |
| 84165 |
|
43 |
42 |
$19.16 |
| 77001 |
|
13 |
12 |
$18.02 |
| J3301 |
Triamcinolone acet inj nos |
16 |
16 |
$17.24 |
| 76937 |
|
13 |
12 |
$16.73 |
| 86705 |
|
71 |
71 |
$15.56 |
| A4649 |
Surgical supplies |
14,373 |
11,636 |
$13.42 |
| 80177 |
|
12 |
12 |
$13.08 |
| G0283 |
Elec stim other than wound |
200 |
68 |
$13.00 |
| 86695 |
|
39 |
39 |
$11.72 |
| 86708 |
|
13 |
12 |
$11.26 |
| J3105 |
Terbutaline sulfate inj |
12 |
12 |
$10.80 |
| 84160 |
|
45 |
44 |
$10.64 |
| 0307 |
|
406 |
381 |
$10.17 |
| 85384 |
|
13 |
12 |
$10.15 |
| S0164 |
Injection pantroprazole |
201 |
149 |
$9.34 |
| 0302 |
|
289 |
280 |
$9.13 |
| 85018 |
|
2,140 |
2,057 |
$8.31 |
| 85014 |
|
101 |
97 |
$5.05 |
| 86849 |
|
12 |
12 |
$4.25 |
| 96376 |
|
484 |
423 |
$3.50 |
| J2543 |
Piperacillin/tazobactam |
137 |
82 |
$2.15 |
| J2471 |
Inj pantoprazole(hikma) 40mg |
22 |
16 |
$1.36 |
| 92551 |
|
671 |
670 |
$0.00 |
| 90716 |
|
98 |
98 |
$0.00 |
| 97032 |
|
828 |
538 |
$0.00 |
| 90723 |
|
87 |
84 |
$0.00 |
| A4335 |
Incontinence supply |
191 |
108 |
$0.00 |
| 99000 |
|
109 |
96 |
$0.00 |
| 0420 |
|
139 |
123 |
$0.00 |
| 0258 |
|
374 |
342 |
$0.00 |
| 81000 |
|
44 |
43 |
$0.00 |
| 99202 |
|
291 |
291 |
$0.00 |
| 0370 |
|
383 |
371 |
$0.00 |
| 0720 |
|
39 |
38 |
$0.00 |
| 0259R |
|
757 |
588 |
$0.00 |
| 94200 |
|
225 |
112 |
$0.00 |
| 92004 |
|
199 |
194 |
$0.00 |
| J2001 |
Lidocaine injection |
110 |
63 |
$0.00 |
| 80050 |
|
90 |
88 |
$0.00 |
| 90651 |
|
52 |
52 |
$0.00 |
| 86580 |
|
39 |
39 |
$0.00 |
| A0427 |
Als1-emergency |
149 |
117 |
$0.00 |
| 94010 |
|
37 |
37 |
$0.00 |
| 93000 |
|
25 |
25 |
$0.00 |
| 98941 |
|
794 |
522 |
$0.00 |
| K0001 |
Standard wheelchair |
38 |
38 |
$0.00 |
| T4535 |
Disposable liner/shield/pad |
418 |
214 |
$0.00 |
| 90647 |
|
80 |
80 |
$0.00 |
| 81050 |
|
12 |
12 |
$0.00 |
| G0467 |
Fqhc visit, estab pt |
129 |
100 |
$0.00 |
| 99385 |
|
14 |
14 |
$0.00 |
| 99239 |
|
19 |
18 |
$0.00 |
| J3420 |
Vitamin b12 injection |
39 |
28 |
$0.00 |
| 90674 |
|
47 |
47 |
$0.00 |
| 84446 |
|
41 |
40 |
$0.00 |
| E0562 |
Humidifier heated used w pap |
143 |
135 |
$0.00 |
| 0410 |
|
28 |
24 |
$0.00 |
| 90686 |
|
68 |
68 |
$0.00 |
| 99403 |
|
13 |
12 |
$0.00 |
| 72082 |
|
16 |
15 |
$0.00 |
| 86063 |
|
25 |
25 |
$0.00 |
| 95886 |
|
12 |
12 |
$0.00 |
| J1030 |
Methylprednisolone 40 mg inj |
83 |
59 |
$0.00 |
| A0380 |
Basic life support mileage |
56 |
30 |
$0.00 |
| 90657 |
|
13 |
13 |
$0.00 |
| 36430 |
|
31 |
27 |
$0.00 |
| 90680 |
|
28 |
27 |
$0.00 |
| 80329 |
|
23 |
20 |
$0.00 |
| 95117 |
|
155 |
62 |
$0.00 |
| 99232 |
|
64 |
19 |
$0.00 |
| 99243 |
|
30 |
30 |
$0.00 |
| 87088 |
|
20 |
19 |
$0.00 |
| 74010 |
|
19 |
13 |
$0.00 |
| E0730 |
Tens four lead |
12 |
12 |
$0.00 |
| 19083 |
|
14 |
14 |
$0.00 |
| 90688 |
|
58 |
54 |
$0.00 |
| 87154 |
|
28 |
27 |
$0.00 |
| 73521 |
|
12 |
12 |
$0.00 |
| J2920 |
Methylprednisolone injection |
17 |
12 |
$0.00 |
| J1920 |
Inj, labetalol hcl, 5mg |
15 |
13 |
$0.00 |
| 81002 |
|
1,269 |
1,031 |
$0.00 |
| 99212 |
|
1,825 |
1,518 |
$0.00 |
| E0601 |
Cont airway pressure device |
232 |
219 |
$0.00 |
| 96103 |
|
39 |
39 |
$0.00 |
| 0122 |
|
26 |
25 |
$0.00 |
| 59425 |
|
445 |
325 |
$0.00 |
| 99201 |
|
722 |
491 |
$0.00 |
| 90700 |
|
38 |
38 |
$0.00 |
| A6250 |
Skin seal protect moisturizr |
193 |
108 |
$0.00 |
| 99391 |
|
123 |
119 |
$0.00 |
| 99392 |
|
760 |
755 |
$0.00 |
| 99203 |
|
526 |
524 |
$0.00 |
| 99396 |
|
61 |
61 |
$0.00 |
| 97755 |
|
258 |
255 |
$0.00 |
| 01967 |
|
78 |
78 |
$0.00 |
| 99204 |
|
78 |
78 |
$0.00 |
| 99394 |
|
117 |
117 |
$0.00 |
| G1004 |
Cdsm ndsc |
143 |
143 |
$0.00 |
| 99173 |
|
722 |
720 |
$0.00 |
| 11721 |
|
84 |
84 |
$0.00 |
| 80326 |
|
229 |
213 |
$0.00 |
| 90670 |
|
305 |
297 |
$0.00 |
| 92552 |
|
238 |
238 |
$0.00 |
| 90633 |
|
165 |
162 |
$0.00 |
| 97012 |
|
793 |
522 |
$0.00 |
| T4541 |
Large disposable underpad |
380 |
209 |
$0.00 |
| Q0091 |
Obtaining screen pap smear |
18 |
18 |
$0.00 |
| H1002 |
Carecoordination prenatal |
56 |
54 |
$0.00 |
| 99393 |
|
366 |
364 |
$0.00 |
| 90472 |
|
275 |
273 |
$0.00 |
| 0272 |
|
57 |
56 |
$0.00 |
| 83525 |
|
141 |
140 |
$0.00 |
| H1003 |
Prenatal at risk education |
107 |
96 |
$0.00 |
| 88175 |
|
63 |
63 |
$0.00 |
| 99215 |
Prolong outpt/office vis |
42 |
41 |
$0.00 |
| 0202U |
|
12 |
12 |
$0.00 |
| 87660 |
|
32 |
32 |
$0.00 |
| 90707 |
|
76 |
76 |
$0.00 |
| S0028 |
Injection, famotidine, 20 mg |
130 |
127 |
$0.00 |
| 99395 |
|
118 |
118 |
$0.00 |
| J1596 |
Inj, glycopyrrolate, 0.1 mg |
12 |
12 |
$0.00 |
| 82731 |
|
12 |
12 |
$0.00 |
| 80361 |
|
78 |
74 |
$0.00 |
| A7035 |
Pos airway press headgear |
12 |
12 |
$0.00 |
| 0402 |
|
63 |
57 |
$0.00 |
| 90734 |
|
44 |
44 |
$0.00 |
| 99490 |
Ccm add 20min |
14 |
14 |
$0.00 |
| 90685 |
|
28 |
28 |
$0.00 |
| 0351 |
|
12 |
12 |
$0.00 |
| 82180 |
|
12 |
12 |
$0.00 |
| 99211 |
|
113 |
54 |
$0.00 |
| 70487 |
|
30 |
25 |
$0.00 |
| 59409 |
|
27 |
26 |
$0.00 |
| 80346 |
|
14 |
13 |
$0.00 |
| 86146 |
|
31 |
26 |
$0.00 |
| 84112 |
|
72 |
62 |
$0.00 |
| 99242 |
|
28 |
28 |
$0.00 |
| 90648 |
|
12 |
12 |
$0.00 |
| J2004 |
Inj, lidocaine w epinephrine |
13 |
13 |
$0.00 |
| A4550 |
Surgical trays |
13 |
13 |
$0.00 |
| A0425 |
Ground mileage |
163 |
129 |
$0.00 |
| 76376 |
|
12 |
12 |
$0.00 |
| 87804 |
|
13 |
13 |
$0.00 |
| E1390 |
Oxygen concentrator |
12 |
12 |
$0.00 |
| 90649 |
|
15 |
15 |
$0.00 |
| 82172 |
|
14 |
14 |
$0.00 |
| A0429 |
Bls-emergency |
23 |
21 |
$0.00 |
| A7038 |
Pos airway pressure filter |
14 |
14 |
$0.00 |
| 93041 |
|
15 |
15 |
$0.00 |
| 90658 |
|
13 |
13 |
$0.00 |