| Code | Description | Claims | Beneficiaries | Total Paid |
| 99283 |
|
41,972 |
38,187 |
$7.91M |
| 99284 |
|
22,548 |
20,210 |
$3.75M |
| G0378 |
Hospital observation per hr |
2,629 |
2,541 |
$3.57M |
| 99285 |
|
15,575 |
12,546 |
$2.10M |
| 99214 |
|
18,531 |
15,775 |
$1.82M |
| 99213 |
|
19,709 |
16,970 |
$1.62M |
| 99282 |
|
5,958 |
5,794 |
$1.18M |
| 99281 |
|
6,018 |
5,433 |
$965K |
| 96361 |
|
6,042 |
5,728 |
$762K |
| 80053 |
|
59,121 |
54,351 |
$642K |
| 99212 |
|
5,331 |
4,711 |
$457K |
| 43239 |
|
736 |
730 |
$448K |
| 59025 |
|
6,356 |
3,155 |
$422K |
| 87536 |
|
5,202 |
5,138 |
$402K |
| 99204 |
|
3,513 |
3,444 |
$398K |
| 93306 |
|
3,373 |
3,308 |
$394K |
| 86480 |
|
6,909 |
6,823 |
$384K |
| G0463 |
Hospital outpt clinic visit |
5,311 |
4,523 |
$371K |
| 96365 |
|
4,554 |
4,035 |
$361K |
| 99391 |
|
3,797 |
3,530 |
$327K |
| 74177 |
|
2,274 |
2,236 |
$299K |
| U0003 |
Cov-19 amp prb hgh thruput |
6,767 |
6,513 |
$282K |
| 99392 |
|
3,423 |
3,392 |
$277K |
| 87491 |
|
12,220 |
11,890 |
$273K |
| 76816 |
|
4,009 |
3,736 |
$272K |
| 90460 |
|
11,459 |
10,094 |
$268K |
| 96372 |
|
10,331 |
9,261 |
$264K |
| 96360 |
|
2,287 |
2,233 |
$258K |
| 99215 |
Prolong outpt/office vis |
1,845 |
1,813 |
$257K |
| 45380 |
|
380 |
379 |
$224K |
| 70450 |
|
2,115 |
2,077 |
$221K |
| 42830 |
|
146 |
146 |
$209K |
| 76811 |
|
1,880 |
1,861 |
$207K |
| P9016 |
Rbc leukocytes reduced |
645 |
573 |
$202K |
| 86850 |
|
10,774 |
9,929 |
$201K |
| 99205 |
Prolong outpt/office vis |
1,497 |
1,491 |
$198K |
| 99203 |
|
2,031 |
2,013 |
$194K |
| 82306 |
|
11,672 |
11,551 |
$186K |
| 76819 |
|
3,738 |
3,235 |
$185K |
| 85025 |
|
55,173 |
51,243 |
$169K |
| 76801 |
|
2,287 |
2,111 |
$169K |
| 86360 |
|
3,730 |
3,630 |
$167K |
| 93975 |
|
856 |
841 |
$165K |
| 99393 |
|
2,002 |
1,993 |
$164K |
| 92567 |
|
3,828 |
3,772 |
$159K |
| 92557 |
|
3,587 |
3,092 |
$149K |
| 90832 |
|
1,023 |
509 |
$145K |
| 90651 |
|
1,561 |
1,556 |
$139K |
| 76818 |
|
1,884 |
1,266 |
$136K |
| 99443 |
|
1,038 |
980 |
$132K |
| 67400 |
|
96 |
96 |
$129K |
| 80061 |
|
16,378 |
16,191 |
$123K |
| 90750 |
|
1,034 |
1,025 |
$122K |
| 77067 |
|
2,926 |
2,853 |
$122K |
| 99442 |
|
1,198 |
1,133 |
$121K |
| 96374 |
|
5,669 |
5,383 |
$120K |
| 96110 |
|
1,899 |
1,889 |
$115K |
| 45378 |
|
184 |
184 |
$114K |
| 96367 |
|
2,037 |
1,245 |
$109K |
| 90677 |
|
1,095 |
1,093 |
$108K |
| 76830 |
|
1,461 |
1,424 |
$105K |
| 87635 |
|
10,317 |
9,904 |
$101K |
| 76820 |
|
3,941 |
3,364 |
$101K |
| 93005 |
|
17,576 |
16,871 |
$101K |
| 76770 |
|
1,278 |
1,225 |
$99K |
| 76856 |
|
1,582 |
1,546 |
$99K |
| 83970 |
|
3,159 |
2,987 |
$98K |
| 92133 |
|
1,931 |
1,788 |
$98K |
| 86900 |
|
10,427 |
9,595 |
$98K |
| 90471 |
|
10,210 |
9,880 |
$95K |
| 76825 |
|
577 |
567 |
$95K |
| 90686 |
|
8,593 |
8,553 |
$93K |
| 0202U |
|
2,539 |
2,503 |
$93K |
| 88305 |
|
3,213 |
3,135 |
$92K |
| 90472 |
|
5,789 |
5,301 |
$87K |
| 95819 |
|
409 |
380 |
$86K |
| 82803 |
|
10,618 |
10,006 |
$86K |
| 76641 |
|
1,813 |
1,572 |
$83K |
| 86359 |
|
3,561 |
3,515 |
$82K |
| 70551 |
|
348 |
344 |
$81K |
| 92134 |
|
1,516 |
1,377 |
$80K |
| 92083 |
|
1,646 |
1,580 |
$77K |
| 83655 |
|
5,723 |
5,669 |
$77K |
| 84443 |
|
12,254 |
12,047 |
$77K |
| 99211 |
|
4,864 |
4,053 |
$76K |
| 99394 |
|
984 |
981 |
$76K |
| 87390 |
|
4,658 |
4,581 |
$76K |
| 80048 |
|
8,879 |
8,646 |
$73K |
| 71275 |
|
572 |
562 |
$73K |
| 90697 |
|
964 |
952 |
$66K |
| 92202 |
|
1,443 |
1,400 |
$65K |
| 96413 |
|
835 |
577 |
$64K |
| 88248 |
|
886 |
854 |
$64K |
| 92285 |
|
1,205 |
1,152 |
$62K |
| 94640 |
|
4,708 |
4,463 |
$61K |
| 71046 |
|
6,834 |
6,716 |
$61K |
| 77063 |
|
2,811 |
2,738 |
$60K |
| 74176 |
|
486 |
478 |
$60K |
| 83036 |
|
13,497 |
13,363 |
$59K |
| 69436 |
|
46 |
46 |
$54K |
| 72082 |
|
1,332 |
1,313 |
$54K |
| 87624 |
|
2,209 |
2,193 |
$53K |
| 86355 |
|
2,064 |
2,036 |
$53K |
| 81220 |
|
282 |
267 |
$52K |
| 90670 |
|
2,798 |
2,771 |
$51K |
| 80197 |
|
7,580 |
3,356 |
$50K |
| 36430 |
|
423 |
358 |
$49K |
| 81001 |
|
15,342 |
14,763 |
$49K |
| 72148 |
|
190 |
189 |
$48K |
| 80307 |
|
2,752 |
2,214 |
$48K |
| 84703 |
|
17,067 |
16,195 |
$48K |
| 99381 |
|
547 |
531 |
$48K |
| 92201 |
|
1,161 |
1,111 |
$47K |
| 86803 |
|
6,626 |
6,533 |
$47K |
| U0005 |
Infec agen detec ampli probe |
3,032 |
2,933 |
$46K |
| Q3014 |
Telehealth facility fee |
2,036 |
1,929 |
$43K |
| 73721 |
|
136 |
134 |
$42K |
| 87591 |
|
1,999 |
1,958 |
$42K |
| 82728 |
|
4,731 |
4,536 |
$42K |
| 90715 |
|
2,324 |
2,305 |
$42K |
| 83880 |
|
3,644 |
3,495 |
$41K |
| 96375 |
|
5,802 |
5,266 |
$41K |
| 76817 |
|
789 |
710 |
$41K |
| 84439 |
|
6,404 |
6,313 |
$41K |
| 84702 |
|
6,724 |
6,017 |
$41K |
| 93970 |
|
306 |
302 |
$41K |
| 90935 |
|
176 |
36 |
$40K |
| G0136 |
Adm of pa/n assess 5-15 m |
1,122 |
1,101 |
$39K |
| 10060 |
|
182 |
180 |
$38K |
| 99202 |
|
446 |
441 |
$36K |
| 73564 |
|
1,286 |
1,254 |
$36K |
| 86706 |
|
5,775 |
5,645 |
$36K |
| 90710 |
|
1,546 |
1,542 |
$36K |
| 83020 |
|
3,053 |
2,919 |
$36K |
| 86769 |
|
1,205 |
1,194 |
$35K |
| 86592 |
|
12,119 |
11,932 |
$33K |
| 92579 |
|
668 |
656 |
$33K |
| 81401 |
|
680 |
647 |
$32K |
| 71045 |
|
7,113 |
6,754 |
$32K |
| 85730 |
|
11,275 |
10,861 |
$32K |
| 81003 |
|
17,031 |
15,828 |
$30K |
| 82607 |
|
3,153 |
3,120 |
$30K |
| 84403 |
|
1,328 |
1,319 |
$29K |
| 85027 |
|
10,609 |
10,432 |
$29K |
| 66982 |
|
15 |
13 |
$29K |
| 87340 |
|
6,047 |
5,882 |
$28K |
| 88304 |
|
1,243 |
1,231 |
$27K |
| 76827 |
|
549 |
541 |
$26K |
| 82670 |
|
1,036 |
1,029 |
$26K |
| 11721 |
|
735 |
716 |
$26K |
| 87086 |
|
5,938 |
5,680 |
$25K |
| 87522 |
Neg quan hep c or qual rna |
795 |
772 |
$24K |
| 94375 |
|
142 |
134 |
$24K |
| 82570 |
|
6,102 |
5,672 |
$24K |
| 90734 |
|
1,180 |
1,174 |
$24K |
| 68810 |
|
50 |
49 |
$24K |
| 54161 |
|
25 |
25 |
$23K |
| 90680 |
|
2,582 |
2,559 |
$23K |
| 76705 |
|
568 |
557 |
$23K |
| 83735 |
|
8,045 |
7,282 |
$22K |
| 80069 |
|
2,760 |
2,472 |
$21K |
| 88342 |
|
464 |
459 |
$20K |
| 94060 |
|
268 |
262 |
$20K |
| 86762 |
|
1,754 |
1,719 |
$19K |
| 84156 |
|
6,280 |
5,812 |
$19K |
| 82043 |
|
4,702 |
4,625 |
$19K |
| 92588 |
|
475 |
468 |
$19K |
| 86161 |
|
2,083 |
2,009 |
$19K |
| 88142 |
|
795 |
778 |
$18K |
| 83550 |
|
4,774 |
4,701 |
$18K |
| 83001 |
|
1,063 |
1,055 |
$17K |
| 51798 |
|
81 |
81 |
$17K |
| 84146 |
|
1,023 |
1,018 |
$17K |
| 73562 |
|
1,583 |
1,523 |
$17K |
| 76000 |
|
282 |
275 |
$17K |
| 83540 |
|
4,863 |
4,782 |
$17K |
| 42820 |
|
13 |
13 |
$16K |
| 86160 |
|
2,094 |
2,018 |
$16K |
| 93325 |
|
766 |
756 |
$16K |
| 83002 |
|
967 |
959 |
$16K |
| 90698 |
|
2,163 |
2,151 |
$16K |
| J0131 |
Inj, acetaminophen (nos) |
4,448 |
4,389 |
$15K |
| 94729 |
|
486 |
486 |
$15K |
| 86140 |
|
5,134 |
4,974 |
$15K |
| 87806 |
|
955 |
942 |
$15K |
| 99441 |
|
223 |
213 |
$15K |
| 73630 |
|
1,502 |
1,463 |
$14K |
| 90633 |
|
1,946 |
1,944 |
$14K |
| 76775 |
|
402 |
401 |
$14K |
| 92020 |
|
325 |
317 |
$14K |
| 83615 |
|
3,707 |
3,357 |
$14K |
| 76805 |
|
153 |
147 |
$14K |
| 84100 |
|
5,522 |
5,070 |
$13K |
| 90732 |
|
364 |
363 |
$13K |
| 73030 |
|
1,210 |
1,179 |
$13K |
| 97802 |
|
182 |
181 |
$13K |
| 99173 |
|
793 |
793 |
$13K |
| 88175 |
|
523 |
519 |
$13K |
| 96415 |
|
54 |
37 |
$12K |
| 82746 |
|
1,516 |
1,503 |
$12K |
| 72100 |
|
641 |
625 |
$12K |
| 86787 |
|
1,950 |
1,910 |
$12K |
| 95812 |
|
85 |
60 |
$12K |
| 73130 |
|
1,082 |
1,044 |
$11K |
| 15731 |
|
15 |
15 |
$11K |
| 84480 |
|
1,884 |
1,865 |
$10K |
| 83605 |
|
9,153 |
8,651 |
$10K |
| 85046 |
|
5,613 |
4,951 |
$10K |
| 84153 |
|
872 |
863 |
$10K |
| 84550 |
|
3,212 |
2,970 |
$10K |
| 96366 |
|
228 |
224 |
$10K |
| 86704 |
|
1,770 |
1,733 |
$9K |
| 73610 |
|
1,210 |
1,176 |
$9K |
| 87850 |
|
3,033 |
3,000 |
$9K |
| 76813 |
|
118 |
117 |
$9K |
| 82248 |
|
2,110 |
1,883 |
$9K |
| 85652 |
|
5,644 |
5,474 |
$9K |
| 86225 |
|
1,775 |
1,736 |
$8K |
| 36415 |
|
3,101 |
3,044 |
$8K |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
1,965 |
1,870 |
$8K |
| 94727 |
|
328 |
328 |
$8K |
| 45385 |
|
13 |
13 |
$8K |
| 77080 |
|
229 |
223 |
$8K |
| 83690 |
|
4,904 |
4,631 |
$8K |
| 80076 |
|
1,325 |
1,297 |
$7K |
| 87798 |
|
467 |
457 |
$7K |
| 82784 |
|
629 |
617 |
$7K |
| 87651 |
|
343 |
337 |
$7K |
| 92014 |
|
173 |
111 |
$7K |
| 90620 |
|
209 |
209 |
$7K |
| 86038 |
|
1,370 |
1,346 |
$7K |
| J1756 |
Iron sucrose injection |
365 |
170 |
$7K |
| 72141 |
|
26 |
26 |
$7K |
| 73110 |
|
717 |
680 |
$7K |
| 76700 |
|
65 |
65 |
$6K |
| 86780 |
|
1,004 |
984 |
$6K |
| 0241U |
|
980 |
970 |
$6K |
| 82105 |
|
939 |
921 |
$6K |
| 84436 |
|
1,934 |
1,910 |
$6K |
| 82950 |
|
1,326 |
1,307 |
$6K |
| 84484 |
|
6,850 |
6,522 |
$6K |
| 87633 |
|
85 |
83 |
$6K |
| 82565 |
|
7,820 |
7,433 |
$6K |
| 76536 |
|
90 |
89 |
$6K |
| 86765 |
|
537 |
532 |
$5K |
| 86709 |
|
976 |
959 |
$5K |
| 96127 |
|
973 |
967 |
$5K |
| 90696 |
|
486 |
485 |
$5K |
| 87661 |
|
333 |
333 |
$5K |
| P9040 |
Rbc leukoreduced irradiated |
13 |
13 |
$5K |
| 94010 |
|
163 |
160 |
$5K |
| 94760 |
|
746 |
698 |
$5K |
| 99395 |
|
67 |
67 |
$5K |
| 97803 |
|
99 |
96 |
$5K |
| J2704 |
Inj, propofol, 10 mg |
3,444 |
3,304 |
$5K |
| 87081 |
|
1,240 |
1,222 |
$5K |
| 93350 |
|
40 |
40 |
$5K |
| J8540 |
Oral dexamethasone |
2,736 |
2,271 |
$5K |
| 96376 |
|
743 |
704 |
$4K |
| 96112 |
|
33 |
33 |
$4K |
| 82550 |
|
1,852 |
1,822 |
$4K |
| 99493 |
|
66 |
66 |
$4K |
| 86735 |
|
527 |
521 |
$4K |
| 90744 |
|
1,223 |
1,214 |
$4K |
| 73590 |
|
601 |
588 |
$4K |
| 82652 |
|
343 |
342 |
$4K |
| 92136 |
|
72 |
63 |
$4K |
| 83525 |
|
363 |
360 |
$4K |
| 72170 |
|
297 |
291 |
$4K |
| J1650 |
Inj enoxaparin sodium |
1,176 |
1,113 |
$4K |
| 95813 |
|
14 |
14 |
$3K |
| 87880 |
|
826 |
819 |
$3K |
| J1885 |
Ketorolac tromethamine inj |
8,470 |
7,970 |
$3K |
| 82627 |
|
161 |
161 |
$3K |
| 73502 |
|
213 |
212 |
$3K |
| 0011A |
|
94 |
77 |
$3K |
| 85008 |
|
679 |
636 |
$3K |
| 90694 |
|
248 |
246 |
$3K |
| 12001 |
|
13 |
13 |
$3K |
| J3490 |
Drugs unclassified injection |
1,201 |
1,168 |
$3K |
| 93976 |
|
52 |
50 |
$3K |
| 88173 |
|
70 |
68 |
$3K |
| 83883 |
|
284 |
282 |
$3K |
| J2001 |
Lidocaine injection |
3,183 |
3,025 |
$3K |
| 85379 |
|
889 |
873 |
$3K |
| 93886 |
|
14 |
13 |
$3K |
| 87517 |
|
99 |
97 |
$2K |
| 94664 |
|
207 |
204 |
$2K |
| 90678 |
|
42 |
41 |
$2K |
| 0012A |
|
65 |
65 |
$2K |
| J1050 |
Medroxyprogesterone acetate |
37 |
36 |
$2K |
| 92225 |
|
62 |
58 |
$2K |
| 86003 |
|
455 |
453 |
$2K |
| 98960 |
|
64 |
64 |
$2K |
| 87070 |
|
439 |
430 |
$2K |
| 85380 |
|
153 |
147 |
$2K |
| 84402 |
|
87 |
86 |
$2K |
| 80074 |
|
112 |
111 |
$2K |
| 99396 |
|
15 |
15 |
$2K |
| J1644 |
Inj heparin sodium per 1000u |
2,010 |
1,068 |
$2K |
| J1100 |
Dexamethasone sodium phos |
5,258 |
4,774 |
$2K |
| J7512 |
Prednisone ir or dr oral 1mg |
783 |
708 |
$2K |
| T1013 |
Sign lang/oral interpreter |
122 |
114 |
$2K |
| 86832 |
|
25 |
24 |
$2K |
| 86664 |
|
179 |
176 |
$2K |
| 72110 |
|
56 |
54 |
$2K |
| 73140 |
|
215 |
202 |
$2K |
| J1170 |
Hydromorphone injection |
912 |
729 |
$2K |
| S0028 |
Injection, famotidine, 20 mg |
2,487 |
2,231 |
$1K |
| 92226 |
|
30 |
28 |
$1K |
| 99496 |
|
12 |
12 |
$1K |
| Q2037 |
Fluvirin vacc, 3 yrs & >, im |
70 |
69 |
$1K |
| J1741 |
Ibuprofen injection |
718 |
683 |
$1K |
| 87486 |
|
85 |
83 |
$1K |
| 87040 |
|
724 |
704 |
$1K |
| 86430 |
|
328 |
324 |
$1K |
| J2250 |
Inj midazolam hydrochloride |
4,481 |
4,392 |
$1K |
| 70486 |
|
13 |
12 |
$1K |
| 73090 |
|
228 |
222 |
$1K |
| J2405 |
Ondansetron hcl injection |
4,890 |
4,516 |
$1K |
| 84165 |
|
205 |
200 |
$1K |
| 73620 |
|
169 |
168 |
$1K |
| J3475 |
Inj magnesium sulfate |
1,269 |
1,169 |
$1K |
| 88307 |
|
31 |
29 |
$1K |
| 86235 |
|
105 |
103 |
$1K |
| J0696 |
Ceftriaxone sodium injection |
2,053 |
1,822 |
$1K |
| 90739 |
|
24 |
24 |
$1K |
| J0690 |
Cefazolin sodium injection |
2,716 |
2,414 |
$1K |
| 99201 |
|
16 |
16 |
$1K |
| 82247 |
|
358 |
298 |
$1K |
| 83520 |
|
115 |
112 |
$1K |
| 93923 |
|
12 |
12 |
$1K |
| 82962 |
|
1,210 |
1,061 |
$960.83 |
| 92025 |
|
13 |
13 |
$947.02 |
| 88300 |
|
157 |
153 |
$935.61 |
| 86790 |
|
145 |
142 |
$926.91 |
| 76514 |
|
12 |
12 |
$922.88 |
| 72125 |
|
29 |
28 |
$876.64 |
| 85007 |
|
542 |
484 |
$868.56 |
| 86644 |
|
105 |
104 |
$856.43 |
| 73552 |
|
86 |
83 |
$853.11 |
| 85384 |
|
223 |
205 |
$837.82 |
| 93017 |
|
28 |
27 |
$834.70 |
| 92558 |
|
13 |
13 |
$805.48 |
| 87581 |
|
85 |
83 |
$787.81 |
| C9290 |
Inj, bupivacaine liposome |
58 |
58 |
$762.09 |
| 90662 |
|
50 |
49 |
$696.57 |
| 95012 |
|
86 |
84 |
$679.68 |
| 82785 |
|
60 |
60 |
$677.80 |
| 86833 |
|
13 |
12 |
$663.85 |
| 87529 |
|
24 |
24 |
$652.46 |
| 93290 |
|
53 |
53 |
$639.42 |
| J3010 |
Fentanyl citrate injection |
4,670 |
4,484 |
$628.93 |
| J1200 |
Diphenhydramine hcl injectio |
1,448 |
1,169 |
$576.95 |
| 90716 |
|
25 |
25 |
$567.07 |
| 0240U |
|
144 |
143 |
$538.18 |
| J2270 |
Morphine sulfate injection |
1,915 |
1,539 |
$536.76 |
| 90707 |
|
24 |
24 |
$518.24 |
| 82330 |
|
428 |
415 |
$515.75 |
| J0456 |
Azithromycin |
90 |
88 |
$491.28 |
| Q0162 |
Ondansetron oral |
2,568 |
2,503 |
$490.68 |
| 76857 |
|
15 |
13 |
$479.12 |
| 82947 |
|
469 |
461 |
$451.22 |
| G0270 |
Mnt subs tx for change dx |
17 |
17 |
$419.92 |
| 84163 |
|
32 |
32 |
$404.26 |
| 92504 |
|
33 |
12 |
$397.50 |
| 83498 |
|
14 |
14 |
$395.59 |
| 82010 |
|
597 |
527 |
$395.51 |
| 73600 |
|
25 |
25 |
$385.25 |
| 73080 |
|
54 |
51 |
$373.47 |
| 77072 |
|
24 |
24 |
$369.62 |
| 86870 |
|
15 |
14 |
$340.93 |
| 84132 |
|
403 |
392 |
$339.10 |
| U0001 |
2019-ncov diagnostic p |
12 |
12 |
$337.38 |
| 84481 |
|
38 |
38 |
$333.95 |
| 84295 |
|
351 |
341 |
$304.15 |
| 86304 |
|
16 |
12 |
$277.21 |
| 86376 |
|
19 |
16 |
$266.44 |
| J1815 |
Insulin injection |
125 |
122 |
$264.40 |
| 86923 |
|
12 |
12 |
$263.19 |
| 86880 |
|
41 |
40 |
$260.76 |
| 93280 |
|
24 |
24 |
$254.37 |
| 82150 |
|
89 |
89 |
$253.76 |
| 73521 |
|
15 |
13 |
$247.33 |
| 83516 |
|
27 |
27 |
$227.47 |
| J2765 |
Metoclopramide hcl injection |
1,922 |
1,829 |
$220.48 |
| 85014 |
|
307 |
297 |
$209.30 |
| 84479 |
|
285 |
276 |
$208.45 |
| J1642 |
Inj heparin sodium per 10 u |
47 |
38 |
$208.05 |
| J0171 |
Adrenalin epinephrine inject |
169 |
146 |
$199.14 |
| 73560 |
|
27 |
27 |
$191.37 |
| 87338 |
|
25 |
25 |
$191.15 |
| 82435 |
|
345 |
336 |
$189.38 |
| 90648 |
|
122 |
119 |
$180.99 |
| 84145 |
|
44 |
42 |
$176.31 |
| 82533 |
|
12 |
12 |
$167.24 |
| 86147 |
|
15 |
15 |
$165.73 |
| 84450 |
|
69 |
65 |
$165.22 |
| 90700 |
|
75 |
73 |
$161.77 |
| 86906 |
|
14 |
12 |
$142.48 |
| 71271 |
|
14 |
14 |
$140.72 |
| 90687 |
|
61 |
61 |
$139.10 |
| 90723 |
|
17 |
16 |
$104.57 |
| J0330 |
Succinycholine chloride inj |
134 |
134 |
$102.00 |
| Q0163 |
Diphenhydramine hcl 50mg |
651 |
569 |
$94.72 |
| 73120 |
|
29 |
28 |
$87.32 |
| 73060 |
|
28 |
28 |
$85.64 |
| 82951 |
|
14 |
14 |
$82.08 |
| 86039 |
|
13 |
13 |
$79.90 |
| 84134 |
|
13 |
12 |
$71.87 |
| 74018 |
|
12 |
12 |
$70.78 |
| 86146 |
|
14 |
13 |
$67.45 |
| G0008 |
Admin influenza virus vac |
12 |
12 |
$42.04 |
| J1580 |
Garamycin gentamicin inj |
85 |
82 |
$29.91 |
| 82952 |
|
17 |
17 |
$27.90 |
| J2370 |
Phenylephrine hcl injection |
97 |
95 |
$16.00 |
| J1630 |
Haloperidol injection |
130 |
122 |
$15.63 |
| J1940 |
Furosemide injection |
13 |
12 |
$4.94 |
| 91301 |
|
123 |
123 |
$0.10 |
| 99080 |
|
1,976 |
794 |
$0.00 |
| J0137 |
Inj, acetaminophen (hikma) |
29 |
27 |
$0.00 |
| J2003 |
Inj, lidocaine hcl, 1 mg |
23 |
23 |
$0.00 |
| 95700 |
|
12 |
12 |
$0.00 |
| 99417 |
Prolong home eval add 15m |
16 |
16 |
$0.00 |