| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 96521 |
|
15,293 |
2,427 |
$2.19M |
| 96365 |
|
32,435 |
7,614 |
$2.02M |
| 99214 |
|
13,989 |
10,337 |
$1.16M |
| J0878 |
Daptomycin injection |
14,060 |
2,294 |
$768K |
| A6253 |
Absorpt drg > 48 sq in w/o b |
6,398 |
1,797 |
$717K |
| J1335 |
Ertapenem injection |
12,863 |
2,270 |
$663K |
| 99232 |
|
12,440 |
4,246 |
$561K |
| 99223 |
Prolong inpt eval add15 m |
3,212 |
2,831 |
$391K |
| A4222 |
Infusion supplies with pump |
8,412 |
1,421 |
$318K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
2,198 |
945 |
$175K |
| Q5103 |
Injection, inflectra |
46 |
40 |
$103K |
| 96374 |
|
2,725 |
634 |
$86K |
| 99215 |
Prolong outpt/office vis |
466 |
400 |
$49K |
| A4649 |
Surgical supplies |
8,891 |
2,205 |
$46K |
| J1745 |
Infliximab not biosimil 10mg |
15 |
12 |
$39K |
| E0781 |
External ambulatory infus pu |
121 |
105 |
$33K |
| 96413 |
|
187 |
181 |
$31K |
| 99205 |
Prolong outpt/office vis |
175 |
169 |
$29K |
| 99233 |
Prolong inpt eval add15 m |
412 |
354 |
$27K |
| 96372 |
|
1,138 |
691 |
$18K |
| J0696 |
Ceftriaxone sodium injection |
4,434 |
827 |
$17K |
| 99222 |
|
150 |
145 |
$16K |
| 36415 |
|
5,598 |
4,224 |
$14K |
| M0243 |
Casirivi and imdevi inj |
57 |
50 |
$13K |
| 96368 |
|
851 |
163 |
$12K |
| 11042 |
|
111 |
69 |
$10K |
| 80053 |
|
1,240 |
981 |
$9K |
| 96415 |
|
172 |
167 |
$8K |
| 29581 |
|
149 |
56 |
$7K |
| 85025 |
|
1,394 |
1,110 |
$7K |
| J3370 |
Vancomycin hcl injection |
360 |
64 |
$6K |
| 36569 |
|
15 |
12 |
$4K |
| 99213 |
|
93 |
76 |
$4K |
| 86140 |
|
878 |
656 |
$3K |
| 85651 |
|
949 |
706 |
$3K |
| 99204 |
|
12 |
12 |
$2K |
| 36589 |
|
15 |
14 |
$2K |
| 11721 |
|
44 |
39 |
$932.36 |
| 96366 |
|
31 |
27 |
$797.51 |
| 96360 |
|
27 |
13 |
$648.83 |
| 82550 |
|
84 |
55 |
$339.87 |
| 0012A |
|
14 |
12 |
$328.00 |
| J2405 |
Ondansetron hcl injection |
447 |
141 |
$133.17 |