| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99284 |
|
7,944 |
6,798 |
$3.27M |
| 99285 |
|
4,695 |
3,909 |
$3.03M |
| 99283 |
|
10,347 |
9,093 |
$2.97M |
| 96374 |
|
1,776 |
1,520 |
$297K |
| 80053 |
|
11,448 |
9,856 |
$185K |
| 74177 |
|
130 |
101 |
$142K |
| 80307 |
|
3,495 |
2,005 |
$113K |
| 99282 |
|
643 |
617 |
$106K |
| 96365 |
|
752 |
634 |
$104K |
| 85025 |
|
12,324 |
10,587 |
$100K |
| 96375 |
|
1,785 |
1,512 |
$92K |
| 93005 |
|
1,840 |
1,555 |
$84K |
| 70450 |
|
176 |
161 |
$75K |
| 0241U |
|
700 |
630 |
$71K |
| 96361 |
|
607 |
490 |
$54K |
| 83605 |
|
3,592 |
2,986 |
$47K |
| 96372 |
|
541 |
461 |
$46K |
| 36415 |
|
13,736 |
11,529 |
$43K |
| 71045 |
|
1,028 |
887 |
$39K |
| 0240U |
|
282 |
251 |
$27K |
| 87804 |
|
1,463 |
792 |
$23K |
| 83735 |
|
1,629 |
1,396 |
$19K |
| J7030 |
Normal saline solution infus |
1,179 |
813 |
$18K |
| 81001 |
|
4,318 |
3,759 |
$16K |
| 87430 |
|
1,010 |
946 |
$16K |
| 84484 |
|
1,402 |
1,134 |
$15K |
| 86140 |
|
1,636 |
1,411 |
$13K |
| J3490 |
Drugs unclassified injection |
1,663 |
1,088 |
$11K |
| 84145 |
|
192 |
162 |
$9K |
| 87040 |
|
1,086 |
735 |
$8K |
| 80305 |
|
1,217 |
1,090 |
$8K |
| 83690 |
|
1,016 |
887 |
$8K |
| 71046 |
|
101 |
95 |
$8K |
| 96360 |
|
35 |
33 |
$8K |
| 87635 |
|
240 |
218 |
$7K |
| 43239 |
|
14 |
12 |
$7K |
| 82150 |
|
1,012 |
881 |
$7K |
| 87081 |
|
787 |
752 |
$6K |
| 80143 |
|
152 |
134 |
$4K |
| 94640 |
|
80 |
61 |
$4K |
| 85610 |
|
487 |
427 |
$4K |
| 85730 |
|
286 |
247 |
$4K |
| 80179 |
|
100 |
88 |
$3K |
| 81025 |
|
367 |
328 |
$3K |
| 83880 |
|
81 |
63 |
$2K |
| 87807 |
|
121 |
120 |
$2K |
| 80320 |
|
287 |
265 |
$2K |
| J2405 |
Ondansetron hcl injection |
659 |
499 |
$1K |
| 87086 |
|
239 |
215 |
$1K |
| J1885 |
Ketorolac tromethamine inj |
182 |
152 |
$901.03 |
| 87428 |
|
12 |
12 |
$894.25 |
| 80048 |
|
93 |
72 |
$733.72 |
| 87186 |
|
62 |
62 |
$716.86 |
| J2250 |
Inj midazolam hydrochloride |
97 |
69 |
$678.35 |
| 82962 |
|
119 |
51 |
$618.40 |
| 96376 |
|
19 |
13 |
$617.38 |
| J3010 |
Fentanyl citrate injection |
84 |
68 |
$533.18 |
| 87077 |
|
42 |
40 |
$477.95 |
| J7042 |
5% dextrose/normal saline |
39 |
26 |
$105.45 |
| J0696 |
Ceftriaxone sodium injection |
174 |
104 |
$70.37 |
| 84703 |
|
17 |
14 |
$69.93 |
| J2270 |
Morphine sulfate injection |
48 |
30 |
$52.56 |
| 85379 |
|
23 |
12 |
$42.08 |
| 81003 |
|
43 |
38 |
$30.84 |
| J7050 |
Normal saline solution infus |
312 |
202 |
$29.15 |
| J1100 |
Dexamethasone sodium phos |
30 |
29 |
$20.16 |
| J1170 |
Hydromorphone injection |
47 |
29 |
$12.56 |
| 82947 |
|
22 |
13 |
$12.18 |
| A4216 |
Sterile water/saline, 10 ml |
65 |
56 |
$0.50 |
| A9270 |
Non-covered item or service |
10,468 |
6,174 |
$0.00 |
| 80329 |
|
16 |
15 |
$0.00 |
| G0480 |
Drug test def 1-7 classes |
12 |
12 |
$0.00 |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
201 |
159 |
$0.00 |