| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 74176 |
|
3,030 |
2,685 |
$1.69M |
| 99283 |
|
12,251 |
10,922 |
$1.61M |
| 99284 |
|
7,804 |
6,792 |
$1.47M |
| 99285 |
|
4,207 |
3,568 |
$1.10M |
| 43239 |
|
1,409 |
1,244 |
$1.01M |
| 80053 |
|
16,661 |
12,773 |
$851K |
| 70450 |
|
2,641 |
2,381 |
$843K |
| 74177 |
|
1,193 |
1,019 |
$650K |
| 85025 |
|
17,589 |
13,672 |
$526K |
| J3490 |
Drugs unclassified injection |
18,027 |
6,821 |
$499K |
| 93005 |
|
8,384 |
6,577 |
$430K |
| 36415 |
|
19,975 |
14,760 |
$397K |
| 45385 |
|
414 |
375 |
$394K |
| 84484 |
|
7,214 |
5,294 |
$343K |
| 71045 |
|
7,246 |
6,241 |
$329K |
| 83880 |
|
2,718 |
2,339 |
$278K |
| 81001 |
|
8,533 |
7,367 |
$270K |
| 71275 |
|
338 |
276 |
$259K |
| 96365 |
|
2,138 |
1,804 |
$243K |
| 80307 |
|
1,611 |
1,338 |
$194K |
| 97110 |
|
2,333 |
588 |
$170K |
| 83690 |
|
4,980 |
4,199 |
$169K |
| 71250 |
|
417 |
379 |
$169K |
| 87040 |
|
4,976 |
2,455 |
$164K |
| 83735 |
|
4,265 |
3,246 |
$158K |
| 80048 |
|
4,350 |
3,586 |
$156K |
| 82553 |
|
2,265 |
1,644 |
$154K |
| 96372 |
|
3,184 |
2,790 |
$145K |
| 95810 |
|
188 |
179 |
$137K |
| 84443 |
|
2,469 |
2,197 |
$136K |
| 96374 |
|
2,298 |
1,950 |
$131K |
| 83605 |
|
3,639 |
2,648 |
$127K |
| 96375 |
|
2,493 |
2,132 |
$127K |
| 87636 |
|
2,445 |
2,148 |
$127K |
| 69436 |
|
186 |
173 |
$126K |
| 71046 |
|
1,617 |
1,478 |
$119K |
| 85027 |
|
3,562 |
2,797 |
$114K |
| 82150 |
|
2,605 |
2,226 |
$113K |
| 99282 |
|
1,594 |
1,477 |
$113K |
| 45380 |
|
141 |
129 |
$109K |
| 85379 |
|
1,710 |
1,511 |
$108K |
| 82550 |
|
2,651 |
1,952 |
$104K |
| 99281 |
|
2,123 |
1,982 |
$102K |
| 96361 |
|
1,510 |
1,316 |
$102K |
| 72125 |
|
291 |
264 |
$102K |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
1,866 |
1,593 |
$101K |
| 85730 |
|
1,766 |
1,577 |
$99K |
| 86710 |
|
1,295 |
1,142 |
$92K |
| 88305 |
|
651 |
549 |
$92K |
| 76700 |
|
331 |
326 |
$84K |
| J2405 |
Ondansetron hcl injection |
3,471 |
2,736 |
$69K |
| 85610 |
|
2,800 |
2,156 |
$64K |
| 87880 |
|
1,900 |
1,700 |
$63K |
| 87086 |
|
1,541 |
1,392 |
$57K |
| J1885 |
Ketorolac tromethamine inj |
4,148 |
3,458 |
$56K |
| 84703 |
|
1,188 |
1,021 |
$55K |
| J2704 |
Inj, propofol, 10 mg |
4,629 |
3,947 |
$53K |
| 80061 |
|
1,499 |
1,379 |
$52K |
| 81025 |
|
1,002 |
847 |
$51K |
| 94640 |
|
1,037 |
707 |
$49K |
| 42820 |
|
64 |
53 |
$49K |
| 83036 |
|
1,425 |
1,290 |
$48K |
| 93971 |
|
280 |
262 |
$46K |
| 45378 |
|
71 |
67 |
$43K |
| 89220 |
|
731 |
646 |
$41K |
| J2250 |
Inj midazolam hydrochloride |
2,489 |
2,098 |
$38K |
| 88342 |
|
204 |
161 |
$36K |
| 76705 |
|
285 |
257 |
$31K |
| 82962 |
|
1,022 |
414 |
$31K |
| 76536 |
|
252 |
247 |
$29K |
| J7030 |
Normal saline solution infus |
4,131 |
2,992 |
$27K |
| G0378 |
Hospital observation per hr |
192 |
168 |
$26K |
| 47562 |
|
19 |
17 |
$26K |
| 87186 |
|
980 |
831 |
$26K |
| 87077 |
|
1,011 |
880 |
$24K |
| 72148 |
|
41 |
41 |
$24K |
| 82306 |
|
291 |
262 |
$22K |
| J3010 |
Fentanyl citrate injection |
2,346 |
1,852 |
$21K |
| 82803 |
|
360 |
289 |
$21K |
| J1100 |
Dexamethasone sodium phos |
1,205 |
977 |
$20K |
| 87635 |
|
940 |
786 |
$18K |
| 73030 |
|
224 |
200 |
$18K |
| 43450 |
|
40 |
38 |
$17K |
| J7040 |
Normal saline solution infus |
2,230 |
2,036 |
$17K |
| 73630 |
|
205 |
189 |
$17K |
| M0243 |
Casirivi and imdevi inj |
100 |
100 |
$16K |
| 73610 |
|
265 |
249 |
$15K |
| J2930 |
Methylprednisolone injection |
964 |
809 |
$15K |
| U0003 |
Cov-19 amp prb hgh thruput |
572 |
407 |
$15K |
| 97161 |
|
169 |
161 |
$14K |
| 96366 |
|
254 |
211 |
$13K |
| 87426 |
|
298 |
274 |
$13K |
| 36600 |
|
279 |
236 |
$13K |
| 80074 |
|
112 |
103 |
$13K |
| J2270 |
Morphine sulfate injection |
617 |
448 |
$13K |
| 76981 |
|
110 |
109 |
$12K |
| 95806 |
|
110 |
101 |
$12K |
| J0696 |
Ceftriaxone sodium injection |
1,508 |
1,266 |
$12K |
| 73502 |
|
93 |
79 |
$10K |
| 87071 |
|
93 |
87 |
$10K |
| 73130 |
|
151 |
146 |
$10K |
| J1650 |
Inj enoxaparin sodium |
243 |
147 |
$10K |
| 72131 |
|
29 |
28 |
$10K |
| 93306 |
|
26 |
25 |
$10K |
| C9803 |
Hopd covid-19 spec collect |
935 |
840 |
$9K |
| 85651 |
|
136 |
122 |
$8K |
| 95811 |
|
12 |
12 |
$8K |
| 90471 |
|
78 |
71 |
$7K |
| 77067 |
|
166 |
162 |
$7K |
| J1170 |
Hydromorphone injection |
396 |
295 |
$6K |
| 71260 |
|
18 |
17 |
$5K |
| J0690 |
Cefazolin sodium injection |
359 |
268 |
$5K |
| 73562 |
|
72 |
69 |
$5K |
| 87205 |
|
98 |
85 |
$5K |
| 72110 |
|
73 |
68 |
$4K |
| 84436 |
|
116 |
102 |
$4K |
| 87522 |
Neg quan hep c or qual rna |
16 |
12 |
$4K |
| 80050 |
|
31 |
26 |
$4K |
| J2710 |
Neostigmine methylslfte inj |
227 |
178 |
$4K |
| 80076 |
|
46 |
42 |
$3K |
| 82607 |
|
70 |
64 |
$3K |
| J0330 |
Succinycholine chloride inj |
462 |
393 |
$3K |
| 84439 |
|
91 |
85 |
$3K |
| J2543 |
Piperacillin/tazobactam |
290 |
199 |
$3K |
| 73110 |
|
39 |
38 |
$3K |
| 74018 |
|
30 |
26 |
$2K |
| 83540 |
|
115 |
109 |
$2K |
| J2550 |
Promethazine hcl injection |
589 |
461 |
$2K |
| 86756 |
|
29 |
28 |
$2K |
| J3475 |
Inj magnesium sulfate |
78 |
52 |
$2K |
| A9537 |
Tc99m mebrofenin |
13 |
13 |
$1K |
| C1889 |
Implant/insert device, noc |
45 |
43 |
$1K |
| J3370 |
Vancomycin hcl injection |
62 |
51 |
$1K |
| L8699 |
Prosthetic implant nos |
18 |
15 |
$1K |
| 88304 |
|
28 |
27 |
$1K |
| 82140 |
|
13 |
12 |
$1K |
| 86140 |
|
35 |
28 |
$810.94 |
| J2060 |
Lorazepam injection |
123 |
93 |
$610.12 |
| 83550 |
|
29 |
27 |
$411.65 |
| 82746 |
|
13 |
13 |
$392.40 |
| C9113 |
Inj pantoprazole sodium, via |
46 |
31 |
$364.10 |
| J0131 |
Inj, acetaminophen (nos) |
16 |
13 |
$180.00 |
| 82977 |
|
13 |
13 |
$128.71 |
| 82248 |
|
15 |
12 |
$99.28 |