| Code | Description | Claims | Beneficiaries | Total Paid |
| 0112 |
|
301 |
289 |
$3.55M |
| 99284 |
|
37,146 |
32,131 |
$3.22M |
| 0121 |
|
229 |
222 |
$1.78M |
| 80053 |
|
51,818 |
43,037 |
$1.71M |
| 77386 |
|
747 |
72 |
$1.65M |
| 74177 |
|
4,157 |
4,029 |
$1.31M |
| 96374 |
|
13,635 |
12,198 |
$1.28M |
| 76815 |
|
13,656 |
8,758 |
$1.24M |
| 0450 |
|
17,595 |
15,581 |
$1.22M |
| 70450 |
|
4,847 |
4,642 |
$1.19M |
| 99231 |
|
19,368 |
14,393 |
$1.17M |
| 96365 |
|
8,274 |
6,174 |
$1.05M |
| 99199 |
|
10,711 |
8,876 |
$1.03M |
| 96375 |
|
12,847 |
10,206 |
$878K |
| 0250 |
|
4,158 |
3,185 |
$793K |
| 93005 |
|
19,293 |
17,718 |
$744K |
| J3490 |
Drugs unclassified injection |
23,111 |
13,715 |
$695K |
| 80307 |
|
7,066 |
6,168 |
$661K |
| 96372 |
|
10,512 |
8,354 |
$560K |
| 85025 |
|
55,402 |
45,149 |
$554K |
| 59025 |
|
11,402 |
4,750 |
$517K |
| 0360 |
|
1,050 |
612 |
$503K |
| 93306 |
|
1,782 |
1,684 |
$494K |
| 76805 |
|
3,553 |
3,496 |
$489K |
| 77067 |
|
3,383 |
3,334 |
$482K |
| 77334 |
|
1,303 |
963 |
$478K |
| 0721 |
|
311 |
303 |
$432K |
| 96361 |
|
8,721 |
6,853 |
$430K |
| 96413 |
|
5,178 |
3,208 |
$425K |
| 82077 |
|
4,032 |
3,568 |
$419K |
| 87636 |
|
1,859 |
1,825 |
$410K |
| 87637 |
|
1,805 |
1,762 |
$399K |
| 99070 |
|
13,725 |
7,740 |
$386K |
| 87635 |
|
5,177 |
4,915 |
$374K |
| 76856 |
|
3,679 |
3,588 |
$348K |
| J0131 |
Inj, acetaminophen (nos) |
4,037 |
2,020 |
$343K |
| 77336 |
|
3,332 |
1,497 |
$341K |
| J1756 |
Iron sucrose injection |
2,018 |
271 |
$324K |
| 76801 |
|
3,468 |
3,020 |
$312K |
| 76830 |
|
3,148 |
3,074 |
$306K |
| 76700 |
|
2,676 |
2,614 |
$298K |
| 96360 |
|
3,060 |
2,584 |
$282K |
| 77412 |
|
2,614 |
323 |
$282K |
| 76817 |
|
3,070 |
2,732 |
$273K |
| J2405 |
Ondansetron hcl injection |
8,755 |
7,135 |
$231K |
| 0510 |
|
5,068 |
3,905 |
$230K |
| 93971 |
|
1,551 |
1,475 |
$227K |
| 71045 |
|
11,411 |
10,721 |
$219K |
| T1999 |
Noc retail items andsupplies |
3,878 |
2,261 |
$213K |
| 77300 |
|
497 |
460 |
$209K |
| 76816 |
|
2,554 |
2,473 |
$204K |
| 71275 |
|
662 |
653 |
$187K |
| 87491 |
|
3,048 |
2,974 |
$171K |
| 87591 |
|
3,055 |
2,979 |
$170K |
| 0301 |
|
874 |
742 |
$165K |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
10,902 |
5,825 |
$162K |
| 74176 |
|
1,006 |
977 |
$155K |
| 99283 |
|
2,468 |
2,236 |
$149K |
| 84484 |
|
12,750 |
10,161 |
$140K |
| J7030 |
Normal saline solution infus |
11,630 |
9,948 |
$133K |
| 0710 |
|
686 |
657 |
$133K |
| 96366 |
|
2,552 |
1,653 |
$128K |
| 71046 |
|
4,072 |
3,902 |
$128K |
| 72125 |
|
416 |
411 |
$116K |
| 90791 |
|
591 |
528 |
$113K |
| 87086 |
|
9,704 |
9,205 |
$108K |
| 66984 |
|
266 |
260 |
$106K |
| 0272 |
|
521 |
503 |
$103K |
| 83690 |
|
11,757 |
10,828 |
$99K |
| J1100 |
Dexamethasone sodium phos |
2,723 |
1,957 |
$98K |
| J0475 |
Baclofen 10 mg injection |
86 |
81 |
$98K |
| 83880 |
|
2,722 |
2,601 |
$97K |
| J1170 |
Hydromorphone injection |
658 |
508 |
$93K |
| 84702 |
|
5,722 |
5,207 |
$90K |
| J2323 |
Natalizumab injection |
40 |
12 |
$85K |
| 97139 |
|
3,249 |
1,035 |
$82K |
| 0171 |
Inj, epinephrine (belcher) |
152 |
150 |
$77K |
| J1200 |
Diphenhydramine hcl injectio |
2,802 |
2,126 |
$75K |
| 99285 |
|
895 |
826 |
$72K |
| 99281 |
|
1,382 |
1,245 |
$70K |
| 86803 |
|
3,757 |
3,694 |
$70K |
| 96367 |
|
1,173 |
858 |
$70K |
| 97110 |
|
3,789 |
1,808 |
$69K |
| 81001 |
|
16,360 |
15,074 |
$66K |
| 0305 |
|
850 |
755 |
$66K |
| 76705 |
|
763 |
743 |
$66K |
| J1885 |
Ketorolac tromethamine inj |
5,955 |
5,610 |
$65K |
| 86703 |
|
3,804 |
3,744 |
$61K |
| 77301 |
|
55 |
54 |
$59K |
| 87502 |
|
531 |
496 |
$59K |
| Z7500 |
|
1,588 |
1,326 |
$54K |
| 80143 |
|
406 |
384 |
$54K |
| 96417 |
|
1,008 |
653 |
$53K |
| J0696 |
Ceftriaxone sodium injection |
2,274 |
2,046 |
$52K |
| J7120 |
Ringers lactate infusion |
4,213 |
3,778 |
$51K |
| 87040 |
|
4,062 |
2,404 |
$51K |
| 94726 |
|
785 |
783 |
$51K |
| 0302 |
|
623 |
575 |
$51K |
| J2270 |
Morphine sulfate injection |
3,672 |
3,094 |
$50K |
| 93798 |
|
1,231 |
192 |
$49K |
| 73030 |
|
1,303 |
1,240 |
$49K |
| 73630 |
|
1,396 |
1,344 |
$49K |
| 94729 |
|
881 |
876 |
$47K |
| 80179 |
|
369 |
352 |
$47K |
| 83735 |
|
6,094 |
4,751 |
$45K |
| 83605 |
|
3,600 |
2,484 |
$45K |
| 84703 |
|
6,306 |
6,023 |
$45K |
| 0370 |
|
150 |
142 |
$43K |
| 73562 |
|
1,246 |
1,201 |
$43K |
| 96415 |
|
846 |
617 |
$42K |
| 73610 |
|
1,034 |
996 |
$41K |
| 93970 |
|
183 |
180 |
$40K |
| U0003 |
Cov-19 amp prb hgh thruput |
411 |
403 |
$39K |
| J2704 |
Inj, propofol, 10 mg |
1,391 |
1,249 |
$39K |
| 84443 |
|
1,840 |
1,789 |
$38K |
| Z9725 |
|
836 |
827 |
$36K |
| 0306 |
|
600 |
545 |
$35K |
| 0460 |
|
58 |
52 |
$33K |
| 0258 |
|
691 |
647 |
$33K |
| 92507 |
|
630 |
231 |
$32K |
| G0108 |
Diab manage trn per indiv |
274 |
215 |
$31K |
| 72100 |
|
735 |
709 |
$30K |
| 76770 |
|
318 |
309 |
$30K |
| 77387 |
|
96 |
12 |
$29K |
| 81025 |
|
4,285 |
3,983 |
$29K |
| 94060 |
|
408 |
407 |
$29K |
| 82731 |
|
467 |
442 |
$27K |
| 0402 |
|
206 |
194 |
$27K |
| 99232 |
|
79 |
79 |
$26K |
| 85610 |
|
5,717 |
5,419 |
$25K |
| 77338 |
|
87 |
82 |
$24K |
| 86850 |
|
3,374 |
3,167 |
$23K |
| 85730 |
|
3,278 |
3,158 |
$22K |
| 0750 |
|
119 |
117 |
$22K |
| J2001 |
Lidocaine injection |
2,657 |
2,038 |
$21K |
| J2250 |
Inj midazolam hydrochloride |
1,825 |
1,643 |
$21K |
| J2765 |
Metoclopramide hcl injection |
2,266 |
2,060 |
$20K |
| 87077 |
|
2,108 |
1,875 |
$20K |
| 97140 |
|
1,479 |
768 |
$20K |
| 73130 |
|
546 |
522 |
$20K |
| 80048 |
|
966 |
853 |
$20K |
| 86900 |
|
5,681 |
4,585 |
$19K |
| 81003 |
|
6,526 |
6,159 |
$19K |
| G0463 |
Hospital outpt clinic visit |
5,033 |
3,547 |
$19K |
| 86901 |
|
4,933 |
4,563 |
$19K |
| 88305 |
|
411 |
324 |
$18K |
| 94010 |
|
528 |
524 |
$18K |
| 82947 |
|
2,588 |
2,378 |
$18K |
| 73502 |
|
364 |
346 |
$17K |
| 94640 |
|
560 |
528 |
$17K |
| 0324 |
|
218 |
203 |
$17K |
| 93017 |
|
183 |
180 |
$16K |
| 87186 |
|
1,734 |
1,576 |
$16K |
| 85379 |
|
1,282 |
1,251 |
$16K |
| 87081 |
|
1,615 |
1,592 |
$16K |
| 95990 |
|
132 |
124 |
$14K |
| J0897 |
Denosumab injection |
14 |
13 |
$14K |
| 80047 |
|
974 |
933 |
$13K |
| J7040 |
Normal saline solution infus |
1,565 |
1,025 |
$13K |
| 97750 |
|
294 |
206 |
$13K |
| 90715 |
|
240 |
237 |
$13K |
| 76536 |
|
158 |
148 |
$12K |
| J2060 |
Lorazepam injection |
1,329 |
1,157 |
$12K |
| 87210 |
|
2,118 |
2,059 |
$12K |
| 0270 |
|
322 |
192 |
$11K |
| 86923 |
|
117 |
61 |
$11K |
| 87633 |
|
19 |
19 |
$11K |
| 0760 |
|
181 |
141 |
$11K |
| 0949 |
|
231 |
213 |
$11K |
| J3475 |
Inj magnesium sulfate |
401 |
252 |
$11K |
| 83615 |
|
2,031 |
1,751 |
$10K |
| 77063 |
|
283 |
281 |
$10K |
| 82570 |
|
1,466 |
1,263 |
$10K |
| 77290 |
|
44 |
40 |
$7K |
| 87651 |
|
166 |
165 |
$7K |
| 36415 |
|
3,149 |
2,341 |
$7K |
| S0164 |
Injection pantroprazole |
382 |
364 |
$7K |
| J2919 |
Inj, methylpred sod succ 5mg |
76 |
55 |
$7K |
| 0730 |
|
216 |
202 |
$6K |
| 77280 |
|
63 |
53 |
$6K |
| 0352 |
|
16 |
13 |
$6K |
| 84439 |
|
352 |
347 |
$6K |
| 84156 |
|
1,440 |
1,230 |
$6K |
| 96402 |
|
163 |
152 |
$6K |
| J3010 |
Fentanyl citrate injection |
711 |
620 |
$6K |
| J1815 |
Insulin injection |
90 |
71 |
$6K |
| 76818 |
|
217 |
146 |
$6K |
| 76820 |
|
193 |
132 |
$6K |
| 99201 |
|
83 |
56 |
$6K |
| 82728 |
|
774 |
739 |
$6K |
| J2930 |
Methylprednisolone injection |
164 |
135 |
$5K |
| 84100 |
|
1,118 |
820 |
$5K |
| J3486 |
Ziprasidone mesylate |
133 |
111 |
$5K |
| 96376 |
|
106 |
89 |
$4K |
| 73110 |
|
109 |
103 |
$4K |
| 93975 |
|
13 |
13 |
$4K |
| 72040 |
|
99 |
92 |
$4K |
| 84550 |
|
729 |
642 |
$4K |
| J0137 |
Inj, acetaminophen (hikma) |
118 |
59 |
$4K |
| J0171 |
Adrenalin epinephrine inject |
180 |
175 |
$4K |
| 72131 |
|
12 |
12 |
$4K |
| 43239 |
|
75 |
75 |
$4K |
| S0020 |
Injection, bupivicaine hydro |
302 |
295 |
$4K |
| 85027 |
|
511 |
489 |
$4K |
| 99202 |
|
49 |
27 |
$4K |
| J7050 |
Normal saline solution infus |
258 |
149 |
$3K |
| 85014 |
|
1,209 |
1,144 |
$3K |
| J2272 |
Inj, morphine (fresenius) |
163 |
149 |
$3K |
| 70496 |
|
15 |
15 |
$3K |
| 0307 |
|
372 |
358 |
$3K |
| 94644 |
|
89 |
80 |
$3K |
| 99282 |
|
85 |
81 |
$3K |
| 86592 |
|
311 |
308 |
$3K |
| 77417 |
|
28 |
13 |
$3K |
| Q3014 |
Telehealth facility fee |
89 |
74 |
$2K |
| 70498 |
|
15 |
15 |
$2K |
| 73560 |
|
89 |
88 |
$2K |
| 0310 |
|
58 |
55 |
$2K |
| 87798 |
|
21 |
20 |
$2K |
| J0690 |
Cefazolin sodium injection |
229 |
222 |
$2K |
| 0300 |
|
234 |
225 |
$2K |
| 87400 |
|
271 |
264 |
$2K |
| 99218 |
|
19 |
13 |
$2K |
| S0028 |
Injection, famotidine, 20 mg |
350 |
311 |
$2K |
| 90471 |
|
260 |
250 |
$2K |
| 84460 |
|
255 |
223 |
$2K |
| 85651 |
|
217 |
213 |
$2K |
| 84450 |
|
256 |
224 |
$2K |
| J2003 |
Inj, lidocaine hcl, 1 mg |
79 |
55 |
$2K |
| J1171 |
Inj, hydromorphone, 0.1 mg |
24 |
15 |
$2K |
| U0002 |
Covid-19 lab test non-cdc |
18 |
18 |
$2K |
| 0420 |
|
21 |
18 |
$1K |
| J7611 |
Albuterol non-comp con |
152 |
89 |
$1K |
| 82565 |
|
210 |
180 |
$1K |
| 83550 |
|
620 |
593 |
$1K |
| 82378 |
|
190 |
163 |
$1K |
| 83540 |
|
672 |
641 |
$1K |
| 73140 |
|
39 |
39 |
$937.37 |
| 84145 |
|
41 |
40 |
$899.36 |
| 87522 |
Neg quan hep c or qual rna |
13 |
12 |
$845.68 |
| J1030 |
Methylprednisolone 40 mg inj |
13 |
13 |
$747.18 |
| 73590 |
|
27 |
27 |
$691.30 |
| Z7502 |
|
17 |
16 |
$688.20 |
| 72020 |
|
29 |
27 |
$678.82 |
| J2470 |
Inj pantoprazole sodium 40mg |
105 |
99 |
$637.59 |
| J2550 |
Promethazine hcl injection |
60 |
53 |
$610.27 |
| 82247 |
|
94 |
71 |
$601.29 |
| 73564 |
|
58 |
58 |
$568.41 |
| J7620 |
Albuterol ipratrop non-comp |
548 |
495 |
$514.71 |
| 0255 |
|
17 |
16 |
$496.67 |
| 82550 |
|
64 |
60 |
$434.66 |
| 72070 |
|
14 |
12 |
$429.20 |
| 86140 |
|
60 |
59 |
$380.07 |
| 82248 |
|
53 |
37 |
$328.75 |
| 99221 |
|
12 |
12 |
$308.88 |
| J7512 |
Prednisone ir or dr oral 1mg |
120 |
113 |
$247.96 |
| 84132 |
|
46 |
40 |
$186.77 |
| J7042 |
5% dextrose/normal saline |
12 |
12 |
$122.87 |
| 87088 |
|
12 |
12 |
$106.84 |
| 82607 |
|
50 |
49 |
$84.08 |
| J3301 |
Triamcinolone acet inj nos |
13 |
12 |
$47.92 |
| J7613 |
Albuterol non-comp unit |
101 |
101 |
$26.20 |
| Q0162 |
Ondansetron oral |
16 |
16 |
$1.44 |
| J0885 |
Epoetin alfa, non-esrd |
20 |
12 |
$0.00 |
| 84112 |
|
30 |
27 |
$0.00 |
| 0250R |
|
438 |
380 |
$0.00 |