| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 0450 |
|
7,381 |
6,777 |
$901K |
| 80053 |
|
5,398 |
5,004 |
$389K |
| T1999 |
Noc retail items andsupplies |
1,375 |
781 |
$303K |
| 99283 |
|
4,883 |
4,595 |
$221K |
| Z7502 |
|
5,012 |
4,988 |
$186K |
| J3490 |
Drugs unclassified injection |
7,138 |
3,569 |
$119K |
| 71046 |
|
1,592 |
1,505 |
$79K |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
745 |
726 |
$78K |
| 80048 |
|
1,072 |
970 |
$77K |
| 87081 |
|
501 |
482 |
$50K |
| 87086 |
|
1,056 |
1,002 |
$46K |
| J7030 |
Normal saline solution infus |
2,752 |
2,405 |
$40K |
| 87420 |
|
291 |
280 |
$39K |
| 88305 |
|
280 |
277 |
$38K |
| Z7610 |
|
2,317 |
1,380 |
$28K |
| 94640 |
|
731 |
574 |
$25K |
| 99282 |
|
1,555 |
1,467 |
$24K |
| 70450 |
|
707 |
680 |
$24K |
| 81001 |
|
5,059 |
4,822 |
$23K |
| 36415 |
|
1,477 |
1,159 |
$19K |
| 71020 |
|
126 |
125 |
$19K |
| 85025 |
|
7,096 |
6,391 |
$18K |
| 96372 |
|
1,111 |
838 |
$17K |
| 96374 |
|
2,068 |
1,922 |
$15K |
| 93005 |
|
3,461 |
2,741 |
$15K |
| 73610 |
|
139 |
137 |
$14K |
| 99285 |
|
754 |
685 |
$13K |
| 87804 |
|
1,351 |
1,301 |
$13K |
| 0710 |
|
536 |
532 |
$13K |
| 73030 |
|
126 |
122 |
$13K |
| 71045 |
|
875 |
825 |
$12K |
| 96375 |
|
1,379 |
1,175 |
$12K |
| 0250 |
|
1,143 |
892 |
$12K |
| 73564 |
|
143 |
133 |
$12K |
| 96361 |
|
1,559 |
1,437 |
$11K |
| 74177 |
|
532 |
521 |
$10K |
| 73630 |
|
162 |
150 |
$10K |
| 99284 |
|
2,545 |
2,345 |
$10K |
| 84702 |
|
695 |
645 |
$9K |
| Z9725 |
|
201 |
199 |
$9K |
| 99281 |
|
285 |
256 |
$9K |
| 97140 |
|
667 |
219 |
$8K |
| 74018 |
|
87 |
85 |
$7K |
| 80306 |
|
514 |
485 |
$6K |
| 96365 |
|
268 |
251 |
$6K |
| 45378 |
|
197 |
195 |
$6K |
| 84484 |
|
1,521 |
1,309 |
$5K |
| J7120 |
Ringers lactate infusion |
17 |
12 |
$5K |
| 76705 |
|
244 |
236 |
$5K |
| 72100 |
|
85 |
83 |
$5K |
| 96413 |
|
82 |
52 |
$5K |
| 72040 |
|
28 |
27 |
$4K |
| J2765 |
Metoclopramide hcl injection |
323 |
300 |
$4K |
| 86850 |
|
48 |
48 |
$3K |
| G0480 |
Drug test def 1-7 classes |
423 |
364 |
$3K |
| 83735 |
|
866 |
768 |
$3K |
| 83880 |
|
496 |
463 |
$3K |
| 96360 |
|
487 |
466 |
$3K |
| 0272 |
|
548 |
467 |
$3K |
| 74176 |
|
252 |
248 |
$3K |
| 84443 |
|
268 |
260 |
$3K |
| 81025 |
|
1,838 |
1,719 |
$3K |
| J2250 |
Inj midazolam hydrochloride |
548 |
533 |
$2K |
| J3010 |
Fentanyl citrate injection |
528 |
524 |
$2K |
| 82962 |
|
693 |
514 |
$2K |
| 82553 |
|
765 |
700 |
$2K |
| 83036 |
|
60 |
53 |
$2K |
| 96367 |
|
73 |
36 |
$2K |
| 94644 |
|
106 |
101 |
$2K |
| J2405 |
Ondansetron hcl injection |
1,462 |
1,286 |
$2K |
| 97110 |
|
676 |
214 |
$2K |
| 43239 |
|
86 |
85 |
$2K |
| 80061 |
|
67 |
58 |
$2K |
| 87040 |
|
372 |
360 |
$1K |
| 82550 |
|
796 |
727 |
$1K |
| 85730 |
|
983 |
928 |
$1K |
| 87077 |
|
373 |
360 |
$1K |
| J1100 |
Dexamethasone sodium phos |
411 |
327 |
$1K |
| 76830 |
|
61 |
57 |
$1K |
| 73130 |
|
33 |
30 |
$1K |
| 83690 |
|
1,932 |
1,806 |
$1K |
| 71275 |
|
12 |
12 |
$931.78 |
| 76700 |
|
60 |
59 |
$884.97 |
| 88342 |
|
32 |
31 |
$813.90 |
| J1200 |
Diphenhydramine hcl injectio |
413 |
303 |
$809.33 |
| J1885 |
Ketorolac tromethamine inj |
1,108 |
1,021 |
$791.47 |
| 76856 |
|
117 |
112 |
$783.66 |
| 85379 |
|
191 |
186 |
$752.11 |
| 87491 |
|
222 |
214 |
$615.75 |
| 87591 |
|
222 |
214 |
$615.07 |
| 45380 |
|
14 |
14 |
$583.68 |
| 0762 |
|
30 |
29 |
$578.53 |
| 96366 |
|
17 |
12 |
$433.87 |
| 85610 |
|
1,375 |
1,289 |
$430.77 |
| 87880 |
|
474 |
462 |
$420.35 |
| 87186 |
|
335 |
325 |
$416.70 |
| 76801 |
|
48 |
41 |
$416.42 |
| 73502 |
|
12 |
12 |
$401.04 |
| 83605 |
|
405 |
384 |
$346.70 |
| 90715 |
|
116 |
114 |
$345.02 |
| 81003 |
|
573 |
529 |
$328.25 |
| J7050 |
Normal saline solution infus |
78 |
45 |
$305.94 |
| J2270 |
Morphine sulfate injection |
675 |
572 |
$277.17 |
| J0696 |
Ceftriaxone sodium injection |
448 |
404 |
$265.40 |
| 86900 |
|
313 |
299 |
$234.15 |
| 72125 |
|
12 |
12 |
$233.66 |
| 76817 |
|
17 |
15 |
$226.10 |
| 86901 |
|
313 |
299 |
$218.02 |
| 82950 |
|
36 |
36 |
$191.00 |
| 45385 |
|
12 |
12 |
$145.20 |
| 0270 |
|
539 |
450 |
$92.76 |
| J1170 |
Hydromorphone injection |
115 |
96 |
$87.44 |
| 87798 |
|
12 |
12 |
$86.50 |
| J2060 |
Lorazepam injection |
169 |
155 |
$31.39 |
| 86140 |
|
92 |
85 |
$31.16 |
| J0780 |
Prochlorperazine injection |
12 |
12 |
$29.37 |
| 85027 |
|
29 |
28 |
$26.69 |
| 82150 |
|
37 |
37 |
$26.09 |
| 87210 |
|
44 |
44 |
$10.36 |
| 90471 |
|
26 |
24 |
$8.92 |
| A9270 |
Non-covered item or service |
3,356 |
2,907 |
$3.30 |
| 0258 |
|
35 |
12 |
$3.16 |
| G0378 |
Hospital observation per hr |
178 |
150 |
$0.00 |
| Q0162 |
Ondansetron oral |
502 |
473 |
$0.00 |
| 96376 |
|
103 |
74 |
$0.00 |
| 66984 |
|
12 |
12 |
$0.00 |
| 93971 |
|
15 |
13 |
$0.00 |
| 73110 |
|
13 |
12 |
$0.00 |
| 71010 |
|
13 |
13 |
$0.00 |