| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| G0463 |
Hospital outpt clinic visit |
72,584 |
24,957 |
$882K |
| A9270 |
Non-covered item or service |
27,153 |
7,491 |
$685K |
| 99283 |
|
8,188 |
6,949 |
$566K |
| 93005 |
|
18,034 |
1,951 |
$264K |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
7,774 |
2,061 |
$165K |
| C9803 |
Hopd covid-19 spec collect |
1,602 |
1,496 |
$138K |
| 80053 |
|
633 |
517 |
$130K |
| 95886 |
|
779 |
702 |
$125K |
| J3490 |
Drugs unclassified injection |
1,946 |
1,155 |
$119K |
| 99284 |
|
1,969 |
1,686 |
$70K |
| 36415 |
|
1,395 |
1,135 |
$64K |
| 95913 |
|
326 |
288 |
$57K |
| J0585 |
Injection,onabotulinumtoxina |
532 |
173 |
$54K |
| G0378 |
Hospital observation per hr |
3,788 |
91 |
$48K |
| 11042 |
|
126 |
50 |
$27K |
| 0241U |
|
193 |
180 |
$27K |
| G0008 |
Admin influenza virus vac |
2,263 |
375 |
$23K |
| U0003 |
Cov-19 amp prb hgh thruput |
1,933 |
1,676 |
$23K |
| 80048 |
|
147 |
130 |
$22K |
| 96375 |
|
455 |
27 |
$21K |
| 99282 |
|
144 |
134 |
$19K |
| J0665 |
Inj, bupivacaine, nos, 0.5mg |
541 |
434 |
$19K |
| A9585 |
Gadobutrol injection |
767 |
387 |
$18K |
| 43239 |
|
73 |
63 |
$14K |
| J1885 |
Ketorolac tromethamine inj |
1,852 |
998 |
$12K |
| 95810 |
|
13 |
12 |
$11K |
| J3010 |
Fentanyl citrate injection |
3,103 |
1,569 |
$10K |
| 90837 |
|
1,358 |
534 |
$10K |
| 99285 |
|
322 |
287 |
$9K |
| U0002 |
Covid-19 lab test non-cdc |
169 |
159 |
$8K |
| J2405 |
Ondansetron hcl injection |
2,246 |
1,233 |
$7K |
| 85025 |
|
1,126 |
952 |
$7K |
| 41899 |
|
85 |
79 |
$6K |
| J1100 |
Dexamethasone sodium phos |
1,285 |
855 |
$6K |
| J3301 |
Triamcinolone acet inj nos |
218 |
62 |
$5K |
| J2003 |
Inj, lidocaine hcl, 1 mg |
112 |
101 |
$5K |
| Q9966 |
Locm 200-299mg/ml iodine,1ml |
232 |
93 |
$5K |
| 87635 |
|
134 |
110 |
$3K |
| 96374 |
|
106 |
95 |
$3K |
| 95887 |
|
168 |
142 |
$3K |
| 0240U |
|
28 |
27 |
$3K |
| J2704 |
Inj, propofol, 10 mg |
3,005 |
2,088 |
$2K |
| 88305 |
|
255 |
226 |
$2K |
| 87651 |
|
97 |
93 |
$2K |
| 76816 |
|
16 |
12 |
$2K |
| 87502 |
|
14 |
14 |
$1K |
| J2250 |
Inj midazolam hydrochloride |
1,145 |
841 |
$1K |
| 0124A |
|
188 |
41 |
$1K |
| G0009 |
Admin pneumococcal vaccine |
235 |
28 |
$1K |
| 99213 |
|
60 |
50 |
$1K |
| 90833 |
|
81 |
39 |
$752.96 |
| 99214 |
|
38 |
18 |
$687.92 |
| 92587 |
|
16 |
13 |
$498.40 |
| 99212 |
|
88 |
67 |
$482.42 |
| E1390 |
Oxygen concentrator |
19 |
19 |
$411.84 |
| 87480 |
|
15 |
13 |
$411.04 |
| 0054A |
|
63 |
14 |
$382.41 |
| 90480 |
|
160 |
27 |
$370.43 |
| J0689 |
Inj cefazolin sodium, baxter |
370 |
220 |
$289.75 |
| 84443 |
|
85 |
79 |
$261.32 |
| J0690 |
Cefazolin sodium injection |
340 |
196 |
$208.95 |
| 87880 |
|
13 |
12 |
$184.42 |
| 84439 |
|
85 |
78 |
$176.10 |
| 97110 |
|
24 |
20 |
$165.20 |
| 99334 |
|
13 |
13 |
$155.35 |
| 98941 |
|
15 |
13 |
$120.63 |
| 71045 |
|
30 |
26 |
$95.99 |
| 90853 |
|
17 |
16 |
$94.18 |
| 93010 |
|
15 |
12 |
$93.81 |
| 97112 |
|
15 |
12 |
$87.65 |
| 86140 |
|
57 |
51 |
$76.08 |
| 85027 |
|
58 |
51 |
$59.68 |
| 82306 |
|
20 |
18 |
$40.21 |
| 85610 |
|
57 |
50 |
$31.48 |
| 85652 |
|
72 |
63 |
$28.41 |
| 90662 |
|
50 |
47 |
$23.75 |
| 82785 |
|
21 |
19 |
$22.36 |
| 87510 |
|
15 |
13 |
$20.05 |
| 87660 |
|
15 |
13 |
$20.05 |
| 87426 |
|
18 |
17 |
$20.00 |
| J7120 |
Ringers lactate infusion |
92 |
82 |
$2.45 |
| 86780 |
|
16 |
12 |
$0.00 |
| 90686 |
|
103 |
100 |
$0.00 |
| J7050 |
Normal saline solution infus |
12 |
12 |
$0.00 |
| 90694 |
|
33 |
33 |
$0.00 |
| 87077 |
|
32 |
25 |
$0.00 |
| 90656 |
|
18 |
18 |
$0.00 |
| 82657 |
|
15 |
13 |
$0.00 |
| 86850 |
|
16 |
12 |
$0.00 |
| 91322 |
|
37 |
37 |
$0.00 |
| 90653 |
|
15 |
15 |
$0.00 |
| 80076 |
|
12 |
12 |
$0.00 |