| Code | Description | Claims | Beneficiaries | Total Paid |
| 96365 |
|
310 |
256 |
$21K |
| 80307 |
|
730 |
578 |
$20K |
| 59025 |
|
370 |
167 |
$14K |
| 74177 |
|
269 |
251 |
$13K |
| 99284 |
|
1,285 |
1,148 |
$10K |
| 70450 |
|
260 |
248 |
$10K |
| 85025 |
|
2,546 |
2,150 |
$8K |
| 80048 |
|
1,650 |
1,373 |
$8K |
| 11042 |
|
241 |
132 |
$8K |
| 97110 |
|
772 |
246 |
$8K |
| 99283 |
|
888 |
848 |
$6K |
| 93306 |
|
140 |
135 |
$6K |
| 72125 |
|
110 |
107 |
$6K |
| 87491 |
|
234 |
210 |
$5K |
| 87591 |
|
234 |
210 |
$5K |
| 36415 |
|
1,245 |
993 |
$5K |
| 80081 |
|
96 |
85 |
$4K |
| T1015 |
Clinic service |
1,713 |
893 |
$4K |
| 80053 |
|
768 |
697 |
$4K |
| 70553 |
|
32 |
32 |
$4K |
| 97161 |
|
130 |
124 |
$3K |
| 71045 |
|
726 |
667 |
$3K |
| 78452 |
|
46 |
42 |
$3K |
| 93005 |
|
754 |
688 |
$3K |
| 71260 |
|
45 |
45 |
$2K |
| 99285 |
|
328 |
302 |
$2K |
| 72148 |
|
49 |
45 |
$2K |
| J1100 |
Dexamethasone sodium phos |
228 |
205 |
$2K |
| 84484 |
|
431 |
335 |
$2K |
| J2405 |
Ondansetron hcl injection |
801 |
667 |
$2K |
| 87086 |
|
649 |
563 |
$2K |
| 87653 |
|
106 |
85 |
$2K |
| 99282 |
|
169 |
165 |
$1K |
| 82077 |
|
211 |
188 |
$1K |
| 83880 |
|
123 |
117 |
$1K |
| 87088 |
|
364 |
320 |
$1K |
| 71250 |
|
34 |
34 |
$1K |
| 74176 |
|
91 |
85 |
$1K |
| 86901 |
|
136 |
125 |
$1K |
| 82947 |
|
425 |
288 |
$1K |
| J2785 |
Regadenoson injection |
42 |
41 |
$965.87 |
| 96374 |
|
994 |
888 |
$925.64 |
| 84443 |
|
128 |
117 |
$923.51 |
| 81025 |
|
442 |
398 |
$906.72 |
| 90715 |
|
74 |
72 |
$879.56 |
| 94726 |
|
58 |
56 |
$858.03 |
| 80047 |
|
69 |
64 |
$770.54 |
| 80143 |
|
95 |
90 |
$770.16 |
| 80179 |
|
94 |
89 |
$727.85 |
| A9575 |
Inj gadoterate meglumi 0.1ml |
59 |
58 |
$713.61 |
| 90686 |
|
44 |
43 |
$711.90 |
| 77067 |
|
98 |
94 |
$646.42 |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
661 |
612 |
$645.48 |
| 83690 |
|
331 |
293 |
$645.46 |
| 82677 |
|
58 |
44 |
$633.83 |
| 86850 |
|
146 |
128 |
$625.46 |
| 94729 |
|
57 |
55 |
$610.42 |
| 88175 |
|
36 |
36 |
$581.00 |
| 12002 |
|
12 |
12 |
$567.50 |
| G0008 |
Admin influenza virus vac |
44 |
43 |
$564.54 |
| 80061 |
|
125 |
117 |
$549.12 |
| 86900 |
|
132 |
121 |
$544.47 |
| 81003 |
|
655 |
560 |
$521.14 |
| 76705 |
|
82 |
80 |
$499.93 |
| 90471 |
|
121 |
94 |
$477.65 |
| 82105 |
|
74 |
58 |
$463.45 |
| 80076 |
|
130 |
118 |
$439.41 |
| 71275 |
|
31 |
29 |
$429.61 |
| 82803 |
|
70 |
67 |
$409.20 |
| 86336 |
|
58 |
44 |
$399.49 |
| 81001 |
|
427 |
396 |
$394.20 |
| 84702 |
|
151 |
112 |
$385.82 |
| J0690 |
Cefazolin sodium injection |
183 |
148 |
$371.82 |
| 80074 |
|
27 |
26 |
$354.93 |
| 85610 |
|
197 |
180 |
$315.89 |
| J1885 |
Ketorolac tromethamine inj |
297 |
213 |
$308.63 |
| 93017 |
|
51 |
47 |
$303.32 |
| 97530 |
|
46 |
28 |
$300.27 |
| 83605 |
|
91 |
85 |
$286.86 |
| 86592 |
|
179 |
140 |
$286.17 |
| J0696 |
Ceftriaxone sodium injection |
88 |
70 |
$266.37 |
| 94760 |
|
29 |
27 |
$259.22 |
| 85730 |
|
65 |
63 |
$257.02 |
| J3010 |
Fentanyl citrate injection |
520 |
404 |
$246.26 |
| 74018 |
|
52 |
49 |
$239.27 |
| 99281 |
|
34 |
34 |
$231.54 |
| 96375 |
|
867 |
749 |
$230.95 |
| G0463 |
Hospital outpt clinic visit |
90 |
69 |
$229.76 |
| U0003 |
Cov-19 amp prb hgh thruput |
837 |
812 |
$227.00 |
| 83036 |
|
64 |
61 |
$223.01 |
| J2250 |
Inj midazolam hydrochloride |
352 |
321 |
$222.04 |
| J2710 |
Neostigmine methylslfte inj |
27 |
13 |
$219.27 |
| 87077 |
|
198 |
178 |
$215.54 |
| 94761 |
|
71 |
69 |
$203.56 |
| 97016 |
|
32 |
14 |
$172.90 |
| 87186 |
|
203 |
182 |
$165.21 |
| 77063 |
|
96 |
92 |
$149.30 |
| A9270 |
Non-covered item or service |
253 |
170 |
$143.46 |
| 73030 |
|
18 |
16 |
$142.57 |
| A9500 |
Tc99m sestamibi |
46 |
42 |
$141.32 |
| 87070 |
|
93 |
84 |
$138.62 |
| 87081 |
|
111 |
103 |
$135.14 |
| 87040 |
|
15 |
12 |
$132.75 |
| J1644 |
Inj heparin sodium per 1000u |
128 |
94 |
$131.66 |
| 36600 |
|
13 |
12 |
$126.09 |
| 87880 |
|
39 |
38 |
$122.99 |
| 87210 |
|
74 |
69 |
$113.10 |
| J7120 |
Ringers lactate infusion |
309 |
268 |
$113.00 |
| 85379 |
|
42 |
41 |
$105.63 |
| 84439 |
|
30 |
27 |
$100.60 |
| J2270 |
Morphine sulfate injection |
298 |
241 |
$98.32 |
| J2704 |
Inj, propofol, 10 mg |
308 |
282 |
$94.84 |
| J2370 |
Phenylephrine hcl injection |
21 |
17 |
$89.89 |
| 76642 |
|
12 |
12 |
$74.36 |
| 87147 |
|
32 |
28 |
$73.90 |
| 83735 |
|
85 |
72 |
$72.15 |
| 97014 |
|
26 |
14 |
$69.24 |
| 94640 |
|
104 |
100 |
$67.62 |
| J1200 |
Diphenhydramine hcl injectio |
175 |
157 |
$62.88 |
| 85027 |
|
69 |
60 |
$60.50 |
| J1815 |
Insulin injection |
41 |
28 |
$58.33 |
| 84703 |
|
47 |
46 |
$53.65 |
| 87635 |
|
1,291 |
1,261 |
$51.31 |
| 72170 |
|
15 |
15 |
$47.67 |
| 80164 |
|
12 |
12 |
$43.90 |
| 70551 |
|
43 |
42 |
$43.01 |
| J2765 |
Metoclopramide hcl injection |
31 |
29 |
$35.88 |
| 87205 |
|
34 |
30 |
$30.50 |
| S0028 |
Injection, famotidine, 20 mg |
263 |
245 |
$27.71 |
| J0330 |
Succinycholine chloride inj |
64 |
58 |
$27.13 |
| J2060 |
Lorazepam injection |
76 |
66 |
$25.70 |
| J1170 |
Hydromorphone injection |
181 |
139 |
$23.52 |
| J0780 |
Prochlorperazine injection |
26 |
25 |
$22.35 |
| J2930 |
Methylprednisolone injection |
16 |
14 |
$17.70 |
| 86140 |
|
54 |
50 |
$16.78 |
| J2550 |
Promethazine hcl injection |
32 |
26 |
$10.88 |
| 83721 |
|
33 |
33 |
$0.00 |
| J7030 |
Normal saline solution infus |
197 |
169 |
$0.00 |
| J7040 |
Normal saline solution infus |
100 |
90 |
$0.00 |
| 71046 |
|
13 |
13 |
$0.00 |
| 72131 |
|
14 |
13 |
$0.00 |
| G0279 |
Tomosynthesis, mammo |
15 |
13 |
$0.00 |
| 84156 |
|
23 |
13 |
$0.00 |
| 97116 |
|
33 |
12 |
$0.00 |
| 36416 |
|
54 |
52 |
$0.00 |
| 97140 |
|
129 |
60 |
$0.00 |
| 96376 |
|
96 |
77 |
$0.00 |
| 87389 |
|
35 |
33 |
$0.00 |
| 96372 |
|
468 |
305 |
$0.00 |
| 74420 |
|
32 |
28 |
$0.00 |
| 93458 |
|
13 |
12 |
$0.00 |
| 0241U |
|
92 |
90 |
$0.00 |
| 94762 |
|
40 |
30 |
$0.00 |
| 99406 |
|
16 |
14 |
$0.00 |
| 73560 |
|
15 |
13 |
$0.00 |
| 93971 |
|
17 |
17 |
$0.00 |
| C1769 |
Guide wire |
18 |
17 |
$0.00 |