| Code | Description | Claims | Beneficiaries | Total Paid |
| 87491 |
|
1,785 |
1,713 |
$35K |
| 84443 |
|
3,554 |
3,477 |
$30K |
| 87591 |
|
1,789 |
1,717 |
$26K |
| 80053 |
|
4,016 |
3,829 |
$22K |
| 99283 |
|
193 |
187 |
$21K |
| 96361 |
|
79 |
65 |
$21K |
| 80061 |
|
3,121 |
3,070 |
$20K |
| 99282 |
|
130 |
126 |
$16K |
| 99284 |
|
215 |
206 |
$15K |
| 85025 |
|
3,307 |
3,142 |
$13K |
| U0003 |
Cov-19 amp prb hgh thruput |
207 |
195 |
$13K |
| 83036 |
|
2,541 |
2,482 |
$11K |
| 87086 |
|
2,234 |
2,124 |
$11K |
| 86803 |
|
1,517 |
1,484 |
$9K |
| 36415 |
|
3,868 |
3,316 |
$9K |
| 87389 |
|
1,227 |
1,200 |
$9K |
| 74177 |
|
59 |
58 |
$9K |
| 86780 |
|
1,297 |
1,264 |
$8K |
| 82306 |
|
787 |
774 |
$8K |
| 82607 |
|
873 |
855 |
$8K |
| 82728 |
|
814 |
797 |
$6K |
| 85027 |
|
1,896 |
1,808 |
$6K |
| 87480 |
|
810 |
785 |
$6K |
| G0463 |
Hospital outpt clinic visit |
92 |
76 |
$5K |
| 87660 |
|
818 |
792 |
$5K |
| 80050 |
|
149 |
138 |
$5K |
| 84439 |
|
711 |
684 |
$5K |
| 87081 |
|
946 |
929 |
$5K |
| 99285 |
|
93 |
91 |
$5K |
| 86870 |
|
110 |
109 |
$5K |
| 87340 |
|
855 |
836 |
$4K |
| 70450 |
|
26 |
25 |
$4K |
| 80307 |
|
64 |
61 |
$4K |
| 87624 |
|
216 |
216 |
$4K |
| 87510 |
|
810 |
785 |
$4K |
| 86762 |
|
475 |
463 |
$4K |
| 59025 |
|
31 |
29 |
$3K |
| 80048 |
|
744 |
663 |
$3K |
| 86850 |
|
810 |
743 |
$3K |
| 82746 |
|
426 |
418 |
$3K |
| 83550 |
|
582 |
573 |
$3K |
| 76856 |
|
24 |
24 |
$3K |
| 93306 |
|
18 |
18 |
$3K |
| 96360 |
|
34 |
33 |
$3K |
| 70553 |
|
12 |
12 |
$2K |
| 83540 |
|
610 |
601 |
$2K |
| 87186 |
|
459 |
437 |
$2K |
| 76705 |
|
26 |
26 |
$2K |
| 76830 |
|
20 |
20 |
$1K |
| 82105 |
|
170 |
165 |
$1K |
| 82570 |
|
443 |
426 |
$1K |
| 86140 |
|
301 |
293 |
$1K |
| 82950 |
|
339 |
332 |
$1K |
| 86787 |
|
242 |
236 |
$1K |
| 84702 |
|
199 |
137 |
$1K |
| 82043 |
|
336 |
330 |
$1K |
| 84153 |
|
132 |
130 |
$1K |
| 76642 |
|
14 |
14 |
$998.21 |
| 96365 |
|
16 |
16 |
$965.52 |
| 71046 |
|
45 |
45 |
$847.23 |
| 83880 |
|
56 |
54 |
$765.04 |
| 86900 |
|
510 |
493 |
$752.15 |
| 87070 |
|
103 |
96 |
$743.93 |
| 86901 |
|
511 |
494 |
$740.97 |
| 81001 |
|
490 |
455 |
$640.84 |
| 87147 |
|
186 |
175 |
$628.82 |
| 77063 |
|
18 |
18 |
$612.06 |
| 93971 |
|
12 |
12 |
$579.62 |
| 86703 |
|
39 |
39 |
$562.50 |
| 82947 |
|
208 |
197 |
$550.88 |
| 86706 |
|
90 |
90 |
$487.82 |
| 96374 |
|
152 |
130 |
$476.93 |
| 87798 |
|
12 |
12 |
$427.73 |
| 85652 |
|
205 |
197 |
$412.50 |
| 92558 |
|
19 |
19 |
$401.55 |
| 73610 |
|
16 |
16 |
$314.00 |
| 80076 |
|
55 |
51 |
$311.13 |
| 77067 |
|
18 |
18 |
$306.11 |
| 86038 |
|
39 |
37 |
$293.74 |
| 86696 |
|
13 |
12 |
$273.55 |
| 87205 |
|
74 |
68 |
$267.13 |
| 83735 |
|
117 |
104 |
$228.17 |
| 86695 |
|
13 |
12 |
$186.42 |
| 87088 |
|
53 |
49 |
$183.38 |
| 87811 |
|
113 |
107 |
$173.06 |
| 73630 |
|
14 |
13 |
$166.49 |
| 82670 |
|
12 |
12 |
$155.69 |
| 83690 |
|
169 |
164 |
$138.20 |
| 87661 |
|
14 |
14 |
$124.79 |
| 80069 |
|
30 |
29 |
$124.25 |
| 84481 |
|
14 |
13 |
$106.73 |
| 83001 |
|
12 |
12 |
$95.86 |
| 93005 |
|
128 |
112 |
$93.13 |
| 73030 |
|
14 |
14 |
$78.72 |
| 88720 |
|
18 |
18 |
$66.95 |
| 82565 |
|
12 |
12 |
$58.65 |
| 84550 |
|
26 |
25 |
$47.09 |
| 85610 |
|
140 |
61 |
$40.15 |
| 71045 |
|
76 |
75 |
$38.88 |
| G0480 |
Drug test def 1-7 classes |
45 |
44 |
$21.98 |
| J0690 |
Cefazolin sodium injection |
36 |
30 |
$9.12 |
| P9604 |
One-way allow prorated trip |
353 |
158 |
$8.80 |
| 84484 |
|
130 |
84 |
$8.36 |
| 84703 |
|
88 |
83 |
$7.30 |
| 81003 |
|
48 |
47 |
$4.07 |
| J2250 |
Inj midazolam hydrochloride |
38 |
33 |
$0.84 |
| 85014 |
|
49 |
44 |
$0.00 |
| 0202U |
|
29 |
29 |
$0.00 |
| J2270 |
Morphine sulfate injection |
15 |
14 |
$0.00 |
| J2405 |
Ondansetron hcl injection |
146 |
121 |
$0.00 |
| J1644 |
Inj heparin sodium per 1000u |
25 |
18 |
$0.00 |
| 80047 |
|
40 |
40 |
$0.00 |
| 96372 |
|
38 |
29 |
$0.00 |
| J0696 |
Ceftriaxone sodium injection |
24 |
19 |
$0.00 |
| 88305 |
|
15 |
14 |
$0.00 |
| 76801 |
|
15 |
13 |
$0.00 |
| J1170 |
Hydromorphone injection |
70 |
56 |
$0.00 |
| U0005 |
Infec agen detec ampli probe |
205 |
193 |
$0.00 |
| J3010 |
Fentanyl citrate injection |
71 |
56 |
$0.00 |
| J1100 |
Dexamethasone sodium phos |
35 |
35 |
$0.00 |
| J1885 |
Ketorolac tromethamine inj |
66 |
55 |
$0.00 |
| A9270 |
Non-covered item or service |
18 |
13 |
$0.00 |
| J1815 |
Insulin injection |
29 |
12 |
$0.00 |
| G0378 |
Hospital observation per hr |
29 |
28 |
$0.00 |
| 96375 |
|
93 |
78 |
$0.00 |
| 76817 |
|
14 |
12 |
$0.00 |
| 83605 |
|
32 |
29 |
$0.00 |
| 96376 |
|
46 |
31 |
$0.00 |
| 0241U |
|
43 |
43 |
$0.00 |
| 82803 |
|
15 |
14 |
$0.00 |