| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 74177 |
|
2,820 |
2,430 |
$342K |
| 0241U |
|
3,661 |
3,019 |
$340K |
| 70450 |
|
4,143 |
3,522 |
$296K |
| 70553 |
|
621 |
502 |
$144K |
| 96365 |
|
2,619 |
2,141 |
$133K |
| 85025 |
|
18,970 |
14,493 |
$132K |
| 80053 |
|
12,737 |
10,445 |
$106K |
| 72125 |
|
971 |
871 |
$100K |
| 93005 |
|
10,116 |
8,047 |
$85K |
| 99283 |
|
2,856 |
2,256 |
$65K |
| 71046 |
|
4,214 |
3,594 |
$63K |
| 84484 |
|
6,915 |
5,188 |
$59K |
| 83880 |
|
2,418 |
1,988 |
$55K |
| 81025 |
|
6,127 |
5,254 |
$51K |
| 36415 |
|
6,842 |
5,447 |
$50K |
| 80048 |
|
8,093 |
5,866 |
$49K |
| 74176 |
|
813 |
708 |
$47K |
| 83690 |
|
5,195 |
4,398 |
$43K |
| 71045 |
|
5,483 |
4,518 |
$40K |
| 80305 |
|
3,278 |
2,732 |
$36K |
| 71275 |
|
222 |
202 |
$35K |
| 81001 |
|
7,174 |
6,091 |
$34K |
| 83735 |
|
4,730 |
3,605 |
$34K |
| 87491 |
|
774 |
705 |
$32K |
| 87591 |
|
775 |
706 |
$32K |
| 99284 |
|
3,833 |
3,051 |
$31K |
| 87804 |
|
1,798 |
1,354 |
$30K |
| 87430 |
|
2,638 |
2,329 |
$29K |
| 83605 |
|
2,473 |
1,933 |
$25K |
| 82550 |
|
2,215 |
1,777 |
$22K |
| 96372 |
|
1,600 |
1,195 |
$22K |
| 70496 |
|
242 |
205 |
$22K |
| J2405 |
Ondansetron hcl injection |
5,555 |
4,321 |
$19K |
| 81003 |
|
5,458 |
4,570 |
$19K |
| 99285 |
|
3,530 |
2,837 |
$18K |
| 87081 |
|
1,931 |
1,697 |
$16K |
| 70498 |
|
146 |
124 |
$15K |
| A9576 |
Inj prohance multipack |
975 |
796 |
$14K |
| J0696 |
Ceftriaxone sodium injection |
2,283 |
1,923 |
$13K |
| 85379 |
|
1,596 |
1,333 |
$13K |
| J1100 |
Dexamethasone sodium phos |
2,102 |
1,711 |
$13K |
| 96374 |
|
2,657 |
2,102 |
$12K |
| 87077 |
|
876 |
761 |
$11K |
| 87040 |
|
1,448 |
710 |
$11K |
| 72131 |
|
95 |
79 |
$11K |
| 80076 |
|
835 |
658 |
$10K |
| 82962 |
|
2,623 |
1,309 |
$10K |
| 85610 |
|
3,967 |
3,131 |
$9K |
| 84145 |
|
635 |
540 |
$9K |
| 73564 |
|
318 |
266 |
$9K |
| 84443 |
|
1,563 |
1,325 |
$8K |
| 87086 |
|
1,231 |
1,049 |
$8K |
| J1885 |
Ketorolac tromethamine inj |
4,388 |
3,661 |
$8K |
| 80320 |
|
688 |
614 |
$8K |
| G0480 |
Drug test def 1-7 classes |
675 |
528 |
$8K |
| 72148 |
|
65 |
51 |
$8K |
| 85027 |
|
1,285 |
1,034 |
$7K |
| 82565 |
|
569 |
447 |
$7K |
| 82553 |
|
1,007 |
799 |
$7K |
| U0003 |
Cov-19 amp prb hgh thruput |
145 |
127 |
$7K |
| 85730 |
|
2,074 |
1,674 |
$7K |
| 86901 |
|
418 |
338 |
$7K |
| 73630 |
|
328 |
289 |
$7K |
| 96375 |
|
2,197 |
1,671 |
$5K |
| 87210 |
|
931 |
831 |
$5K |
| 73610 |
|
229 |
200 |
$5K |
| 84703 |
|
434 |
378 |
$4K |
| 87635 |
|
1,438 |
1,242 |
$4K |
| 73030 |
|
202 |
179 |
$4K |
| 73130 |
|
119 |
109 |
$3K |
| 80050 |
|
53 |
52 |
$2K |
| 87428 |
|
63 |
62 |
$2K |
| 80061 |
|
425 |
378 |
$2K |
| 72110 |
|
84 |
77 |
$2K |
| 86900 |
|
418 |
338 |
$2K |
| 96361 |
|
769 |
591 |
$1K |
| 70551 |
|
16 |
13 |
$1K |
| 82803 |
|
80 |
52 |
$1K |
| J2930 |
Methylprednisolone injection |
717 |
585 |
$1K |
| 84439 |
|
357 |
322 |
$990.32 |
| 84702 |
|
87 |
78 |
$941.46 |
| 90715 |
|
61 |
55 |
$900.58 |
| 82306 |
|
158 |
145 |
$899.08 |
| 87186 |
|
176 |
160 |
$886.89 |
| 87420 |
|
73 |
70 |
$874.63 |
| J2270 |
Morphine sulfate injection |
3,702 |
2,764 |
$729.52 |
| 95810 |
|
13 |
12 |
$691.68 |
| J0561 |
Penicillin g benzathine inj |
14 |
13 |
$679.20 |
| 76705 |
|
41 |
37 |
$555.52 |
| 72100 |
|
33 |
24 |
$553.65 |
| J2060 |
Lorazepam injection |
896 |
754 |
$535.59 |
| 94640 |
|
255 |
164 |
$473.30 |
| 82607 |
|
95 |
85 |
$419.99 |
| 84481 |
|
95 |
86 |
$419.31 |
| 72040 |
|
33 |
24 |
$407.05 |
| J1200 |
Diphenhydramine hcl injectio |
1,157 |
931 |
$349.80 |
| J2250 |
Inj midazolam hydrochloride |
519 |
379 |
$335.74 |
| 73110 |
|
17 |
12 |
$326.93 |
| 82746 |
|
68 |
60 |
$266.82 |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
2,643 |
2,131 |
$235.36 |
| 73502 |
|
14 |
14 |
$230.24 |
| 99282 |
|
15 |
13 |
$204.13 |
| J3010 |
Fentanyl citrate injection |
927 |
651 |
$198.05 |
| A9270 |
Non-covered item or service |
4,096 |
2,629 |
$192.97 |
| 86850 |
|
76 |
65 |
$189.05 |
| 96376 |
|
58 |
38 |
$168.55 |
| 82009 |
|
35 |
24 |
$139.64 |
| 83036 |
|
53 |
53 |
$138.70 |
| J0780 |
Prochlorperazine injection |
430 |
342 |
$129.63 |
| 82270 |
|
29 |
27 |
$125.16 |
| 80329 |
|
14 |
13 |
$118.58 |
| J1170 |
Hydromorphone injection |
1,122 |
709 |
$106.66 |
| 84132 |
|
16 |
13 |
$73.82 |
| J1644 |
Inj heparin sodium per 1000u |
140 |
78 |
$52.66 |
| J2550 |
Promethazine hcl injection |
131 |
96 |
$38.08 |
| 81015 |
|
190 |
164 |
$33.89 |
| J0692 |
Cefepime hcl for injection |
18 |
12 |
$29.12 |
| 83721 |
|
59 |
54 |
$27.24 |
| J1790 |
Droperidol injection |
12 |
12 |
$7.60 |
| J2704 |
Inj, propofol, 10 mg |
66 |
37 |
$6.48 |
| J1171 |
Inj, hydromorphone, 0.1 mg |
20 |
13 |
$5.40 |
| 36416 |
|
28 |
27 |
$0.00 |
| 36600 |
|
62 |
40 |
$0.00 |
| J7030 |
Normal saline solution infus |
133 |
116 |
$0.00 |