| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99283 |
|
1,549 |
1,395 |
$211K |
| 99284 |
|
563 |
504 |
$96K |
| G0378 |
Hospital observation per hr |
196 |
156 |
$66K |
| 99285 |
|
584 |
500 |
$54K |
| 74176 |
|
29 |
25 |
$8K |
| 74177 |
|
15 |
13 |
$5K |
| 96361 |
|
728 |
597 |
$2K |
| 99282 |
|
30 |
28 |
$2K |
| 96374 |
|
786 |
645 |
$302.54 |
| 96372 |
|
427 |
373 |
$228.92 |
| 80053 |
|
970 |
805 |
$226.81 |
| 85025 |
|
1,053 |
866 |
$177.60 |
| 96375 |
|
645 |
521 |
$160.44 |
| 87635 |
|
196 |
189 |
$153.93 |
| A4649 |
Surgical supplies |
642 |
515 |
$67.90 |
| 87428 |
|
378 |
342 |
$63.59 |
| J7030 |
Normal saline solution infus |
735 |
447 |
$45.62 |
| A4208 |
3 cc sterile syringe&needle |
836 |
698 |
$20.70 |
| S1015 |
Iv tubing extension set |
129 |
115 |
$19.60 |
| 71045 |
|
377 |
338 |
$17.67 |
| 87899 |
|
91 |
87 |
$16.54 |
| A4215 |
Sterile needle |
951 |
793 |
$10.64 |
| J2405 |
Ondansetron hcl injection |
183 |
133 |
$9.60 |
| 81002 |
|
506 |
428 |
$9.41 |
| 87804 |
|
91 |
87 |
$8.85 |
| J1885 |
Ketorolac tromethamine inj |
642 |
525 |
$6.82 |
| 81000 |
|
66 |
62 |
$5.16 |
| S5001 |
Prescription drug,brand name |
88 |
68 |
$4.55 |
| A4216 |
Sterile water/saline, 10 ml |
747 |
617 |
$1.24 |
| A4209 |
5+ cc sterile syringe&needle |
13 |
12 |
$0.54 |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
20 |
16 |
$0.12 |
| 87651 |
|
101 |
92 |
$0.00 |
| J1100 |
Dexamethasone sodium phos |
72 |
44 |
$0.00 |
| J7050 |
Normal saline solution infus |
49 |
27 |
$0.00 |
| J0696 |
Ceftriaxone sodium injection |
33 |
25 |
$0.00 |
| 96365 |
|
17 |
12 |
$0.00 |
| 36415 |
|
31 |
25 |
$0.00 |
| 96360 |
|
59 |
45 |
$0.00 |
| A4223 |
Infusion supplies w/o pump |
81 |
71 |
$0.00 |
| A4222 |
Infusion supplies with pump |
15 |
13 |
$0.00 |
| 99072 |
|
14 |
14 |
$0.00 |
| 87634 |
|
31 |
28 |
$0.00 |
| J7040 |
Normal saline solution infus |
30 |
14 |
$0.00 |
| J8499 |
Oral prescrip drug non chemo |
50 |
42 |
$0.00 |
| J7120 |
Ringers lactate infusion |
24 |
18 |
$0.00 |
| S5000 |
Prescription drug, generic |
20 |
17 |
$0.00 |