| Code | Description | Claims | Beneficiaries | Total Paid |
| 0450 |
|
192,336 |
167,945 |
$21.33M |
| 74177 |
|
12,079 |
11,655 |
$5.17M |
| 96374 |
|
30,652 |
27,576 |
$2.74M |
| 70450 |
|
10,562 |
10,180 |
$2.53M |
| 87636 |
|
11,687 |
11,347 |
$1.98M |
| 72125 |
|
4,414 |
4,283 |
$1.95M |
| 80053 |
|
103,885 |
92,412 |
$1.61M |
| 87637 |
|
9,193 |
8,962 |
$1.55M |
| 96375 |
|
24,058 |
20,524 |
$1.52M |
| 99213 |
|
1,648 |
748 |
$1.43M |
| 71260 |
|
2,267 |
2,182 |
$1.43M |
| 0762 |
|
1,588 |
879 |
$1.31M |
| 93005 |
|
38,687 |
35,218 |
$1.27M |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
23,581 |
14,668 |
$1.27M |
| 80307 |
|
11,457 |
10,407 |
$1.15M |
| 85025 |
|
114,520 |
99,963 |
$1.06M |
| 87635 |
|
16,180 |
15,480 |
$1.04M |
| 71046 |
|
31,938 |
30,476 |
$953K |
| 0160 |
|
1,574 |
813 |
$876K |
| 0270 |
|
22,233 |
12,311 |
$845K |
| 99284 |
|
4,854 |
4,476 |
$841K |
| 96365 |
|
7,138 |
6,102 |
$837K |
| 99285 |
|
2,944 |
2,708 |
$799K |
| 96372 |
|
19,276 |
17,023 |
$776K |
| T1999 |
Noc retail items andsupplies |
19,053 |
9,110 |
$722K |
| 74176 |
|
4,306 |
4,175 |
$687K |
| J3490 |
Drugs unclassified injection |
20,041 |
11,088 |
$673K |
| 96361 |
|
13,325 |
11,830 |
$646K |
| 0250 |
|
44,118 |
24,692 |
$589K |
| 82077 |
|
5,352 |
4,909 |
$521K |
| 99281 |
|
6,283 |
5,735 |
$518K |
| 99283 |
|
3,320 |
3,038 |
$477K |
| Z7502 |
|
12,970 |
12,772 |
$464K |
| 76705 |
|
4,616 |
4,445 |
$457K |
| 71045 |
|
16,627 |
15,349 |
$411K |
| 87502 |
|
4,272 |
4,142 |
$405K |
| U0003 |
Cov-19 amp prb hgh thruput |
4,539 |
4,462 |
$392K |
| 84484 |
|
34,619 |
27,233 |
$384K |
| J1745 |
Infliximab not biosimil 10mg |
87 |
76 |
$365K |
| 96360 |
|
3,899 |
3,774 |
$346K |
| 99199 |
|
874 |
773 |
$343K |
| 83690 |
|
39,409 |
35,958 |
$340K |
| 87591 |
|
6,074 |
5,894 |
$334K |
| 87491 |
|
6,043 |
5,863 |
$333K |
| J2405 |
Ondansetron hcl injection |
15,150 |
13,164 |
$326K |
| 96376 |
|
689 |
534 |
$308K |
| 71275 |
|
1,275 |
1,255 |
$302K |
| 93971 |
|
2,181 |
2,123 |
$298K |
| 76801 |
|
3,386 |
2,984 |
$281K |
| 80143 |
|
2,772 |
2,534 |
$267K |
| J0131 |
Inj, acetaminophen (nos) |
2,466 |
1,255 |
$251K |
| 81001 |
|
56,167 |
51,765 |
$248K |
| 80179 |
|
2,675 |
2,466 |
$248K |
| 76856 |
|
2,886 |
2,807 |
$242K |
| 70486 |
|
688 |
677 |
$229K |
| J1100 |
Dexamethasone sodium phos |
5,749 |
5,155 |
$228K |
| 0202U |
|
385 |
381 |
$227K |
| J1885 |
Ketorolac tromethamine inj |
17,399 |
16,226 |
$226K |
| 83880 |
|
6,625 |
6,048 |
$221K |
| 70551 |
|
603 |
591 |
$220K |
| 80048 |
|
5,285 |
4,903 |
$220K |
| J7030 |
Normal saline solution infus |
14,590 |
13,063 |
$198K |
| 87086 |
|
16,064 |
15,033 |
$184K |
| 76830 |
|
2,158 |
2,094 |
$179K |
| 76817 |
|
2,145 |
1,888 |
$178K |
| 82803 |
|
5,819 |
5,263 |
$177K |
| 81025 |
|
24,336 |
22,897 |
$177K |
| J0696 |
Ceftriaxone sodium injection |
7,647 |
7,005 |
$175K |
| 73030 |
|
2,889 |
2,798 |
$170K |
| 73562 |
|
3,654 |
3,500 |
$167K |
| J2270 |
Morphine sulfate injection |
11,250 |
9,288 |
$155K |
| 87651 |
|
3,313 |
3,264 |
$140K |
| 90715 |
|
1,804 |
1,767 |
$138K |
| 73630 |
|
3,648 |
3,538 |
$135K |
| 73130 |
|
2,828 |
2,700 |
$133K |
| 73610 |
|
3,210 |
3,104 |
$130K |
| 96366 |
|
2,077 |
1,770 |
$129K |
| 87040 |
|
9,221 |
5,365 |
$128K |
| 83605 |
|
8,127 |
6,567 |
$121K |
| 84443 |
|
5,294 |
5,079 |
$102K |
| 94640 |
|
3,117 |
2,699 |
$101K |
| J7120 |
Ringers lactate infusion |
8,151 |
7,404 |
$98K |
| 84702 |
|
6,644 |
5,718 |
$98K |
| 85730 |
|
7,200 |
6,821 |
$95K |
| J1170 |
Hydromorphone injection |
5,530 |
4,209 |
$94K |
| 83735 |
|
11,553 |
10,226 |
$91K |
| 0510 |
|
2,468 |
2,097 |
$89K |
| 84703 |
|
11,007 |
10,458 |
$89K |
| 96413 |
|
2,120 |
1,493 |
$87K |
| 87634 |
|
1,329 |
1,298 |
$85K |
| 73110 |
|
1,796 |
1,725 |
$82K |
| 72100 |
|
1,966 |
1,933 |
$81K |
| 85610 |
|
9,773 |
9,117 |
$68K |
| 86901 |
|
6,671 |
5,260 |
$66K |
| 86900 |
|
6,929 |
5,220 |
$63K |
| 86850 |
|
3,575 |
3,370 |
$63K |
| 87186 |
|
4,535 |
4,123 |
$58K |
| 82330 |
|
3,084 |
2,820 |
$58K |
| 99211 |
|
1,342 |
988 |
$56K |
| 73080 |
|
1,137 |
1,108 |
$56K |
| 73590 |
|
1,163 |
1,113 |
$50K |
| 0761 |
|
1,083 |
775 |
$47K |
| 70496 |
|
188 |
183 |
$47K |
| 73502 |
|
1,014 |
995 |
$46K |
| 87633 |
|
121 |
121 |
$46K |
| J1200 |
Diphenhydramine hcl injectio |
4,869 |
4,331 |
$45K |
| J3010 |
Fentanyl citrate injection |
2,204 |
2,004 |
$44K |
| 87077 |
|
3,995 |
3,559 |
$44K |
| J2765 |
Metoclopramide hcl injection |
4,629 |
4,239 |
$42K |
| 85379 |
|
3,297 |
3,210 |
$41K |
| 93458 |
|
62 |
62 |
$41K |
| 93306 |
|
306 |
293 |
$41K |
| 99282 |
|
200 |
189 |
$40K |
| 76870 |
|
548 |
533 |
$38K |
| J1815 |
Insulin injection |
1,603 |
1,056 |
$38K |
| 82947 |
|
5,723 |
5,142 |
$36K |
| 73090 |
|
739 |
718 |
$35K |
| 70491 |
|
140 |
138 |
$35K |
| J0780 |
Prochlorperazine injection |
1,931 |
1,815 |
$34K |
| 87400 |
|
2,994 |
2,664 |
$29K |
| 93970 |
|
147 |
146 |
$29K |
| 74019 |
|
841 |
820 |
$28K |
| J2060 |
Lorazepam injection |
2,726 |
2,335 |
$28K |
| 84145 |
|
1,188 |
1,154 |
$27K |
| 70498 |
|
138 |
134 |
$27K |
| 86140 |
|
3,981 |
3,808 |
$27K |
| 96415 |
|
750 |
657 |
$26K |
| 72148 |
|
57 |
52 |
$26K |
| 0760 |
|
600 |
458 |
$26K |
| 90471 |
|
1,999 |
1,925 |
$25K |
| 81003 |
|
7,646 |
7,288 |
$24K |
| 87798 |
|
283 |
268 |
$23K |
| 87081 |
|
2,499 |
2,384 |
$23K |
| 87430 |
|
1,654 |
1,598 |
$21K |
| J7040 |
Normal saline solution infus |
2,317 |
1,982 |
$20K |
| 78452 |
|
120 |
109 |
$19K |
| 73140 |
|
788 |
774 |
$18K |
| J2930 |
Methylprednisolone injection |
1,018 |
895 |
$17K |
| 96367 |
|
354 |
298 |
$15K |
| 71020 |
|
331 |
140 |
$15K |
| 76770 |
|
153 |
146 |
$15K |
| 84132 |
|
1,872 |
1,697 |
$13K |
| 76815 |
|
402 |
324 |
$12K |
| 87210 |
|
1,934 |
1,883 |
$12K |
| J1644 |
Inj heparin sodium per 1000u |
1,012 |
470 |
$11K |
| J0561 |
Penicillin g benzathine inj |
25 |
25 |
$11K |
| A9502 |
Tc99m tetrofosmin |
77 |
68 |
$10K |
| 82550 |
|
1,351 |
1,095 |
$10K |
| 86923 |
|
62 |
39 |
$10K |
| 94644 |
|
298 |
257 |
$9K |
| 36415 |
|
1,141 |
988 |
$9K |
| 29125 |
|
13 |
13 |
$9K |
| 84295 |
|
1,332 |
1,254 |
$9K |
| 93798 |
|
297 |
58 |
$9K |
| L0172 |
Cerv col sr foam 2pc pre ots |
104 |
103 |
$9K |
| 87088 |
|
858 |
786 |
$9K |
| S0164 |
Injection pantroprazole |
488 |
378 |
$8K |
| J2785 |
Regadenoson injection |
51 |
44 |
$8K |
| Q0162 |
Ondansetron oral |
157 |
152 |
$8K |
| J1953 |
Levetiracetam injection |
80 |
48 |
$8K |
| 87420 |
|
1,381 |
1,306 |
$8K |
| 72040 |
|
139 |
131 |
$8K |
| 74018 |
|
309 |
299 |
$8K |
| 84100 |
|
1,518 |
1,380 |
$8K |
| 72141 |
|
13 |
13 |
$7K |
| 83036 |
|
1,155 |
1,127 |
$7K |
| 73552 |
|
144 |
142 |
$7K |
| J1940 |
Furosemide injection |
646 |
472 |
$7K |
| 71250 |
|
39 |
39 |
$7K |
| 85652 |
|
1,931 |
1,853 |
$6K |
| J7050 |
Normal saline solution infus |
361 |
245 |
$6K |
| 87581 |
|
184 |
183 |
$6K |
| 87486 |
|
184 |
183 |
$6K |
| 72131 |
|
28 |
27 |
$6K |
| Z7610 |
|
704 |
396 |
$5K |
| 73060 |
|
151 |
149 |
$5K |
| A9585 |
Gadobutrol injection |
139 |
114 |
$5K |
| J3475 |
Inj magnesium sulfate |
284 |
250 |
$4K |
| 81002 |
|
1,356 |
1,320 |
$4K |
| 80076 |
|
321 |
309 |
$4K |
| 87150 |
|
13 |
13 |
$4K |
| 86592 |
|
804 |
799 |
$4K |
| 93017 |
|
122 |
111 |
$4K |
| J3370 |
Vancomycin hcl injection |
182 |
140 |
$4K |
| 71010 |
|
115 |
42 |
$4K |
| G0463 |
Hospital outpt clinic visit |
256 |
237 |
$4K |
| 82009 |
|
690 |
629 |
$3K |
| 72070 |
|
75 |
72 |
$3K |
| J7611 |
Albuterol non-comp con |
1,340 |
1,233 |
$3K |
| 86308 |
|
603 |
597 |
$3K |
| 0324 |
|
38 |
38 |
$3K |
| 80061 |
|
347 |
322 |
$3K |
| J2250 |
Inj midazolam hydrochloride |
471 |
459 |
$3K |
| J0137 |
Inj, acetaminophen (hikma) |
70 |
35 |
$2K |
| 82553 |
|
256 |
164 |
$2K |
| 72170 |
|
86 |
85 |
$2K |
| 84439 |
|
244 |
238 |
$2K |
| U0005 |
Infec agen detec ampli probe |
99 |
97 |
$2K |
| J0360 |
Hydralazine hcl injection |
109 |
92 |
$2K |
| 87147 |
|
352 |
308 |
$2K |
| 99070 |
|
128 |
77 |
$2K |
| Z9725 |
|
41 |
40 |
$2K |
| J7620 |
Albuterol ipratrop non-comp |
452 |
283 |
$2K |
| J8540 |
Oral dexamethasone |
158 |
89 |
$1K |
| 87045 |
|
110 |
109 |
$1K |
| 87070 |
|
150 |
134 |
$1K |
| L1830 |
Ko immob canvas long pre ots |
12 |
12 |
$1K |
| 87205 |
|
267 |
245 |
$1K |
| 87427 |
|
97 |
96 |
$1K |
| 97139 |
|
24 |
12 |
$1K |
| 97750 |
|
31 |
25 |
$1K |
| 87046 |
|
169 |
109 |
$1K |
| 71101 |
|
26 |
25 |
$1K |
| 87899 |
|
141 |
138 |
$1K |
| J2704 |
Inj, propofol, 10 mg |
130 |
126 |
$1K |
| J2550 |
Promethazine hcl injection |
92 |
82 |
$964.37 |
| 10060 |
|
31 |
26 |
$900.00 |
| L3908 |
Who cock-up nonmolde pre ots |
13 |
13 |
$886.50 |
| 87015 |
|
97 |
96 |
$819.11 |
| J2543 |
Piperacillin/tazobactam |
13 |
13 |
$780.89 |
| J2001 |
Lidocaine injection |
358 |
290 |
$650.98 |
| J3360 |
Diazepam injection |
33 |
29 |
$628.31 |
| 82140 |
|
53 |
42 |
$599.82 |
| J0690 |
Cefazolin sodium injection |
108 |
96 |
$539.94 |
| J1171 |
Inj, hydromorphone, 0.1 mg |
15 |
12 |
$508.51 |
| 73660 |
|
24 |
24 |
$507.98 |
| 85002 |
|
17 |
15 |
$464.35 |
| J1650 |
Inj enoxaparin sodium |
24 |
13 |
$401.82 |
| 0636 |
|
258 |
209 |
$211.88 |
| J7512 |
Prednisone ir or dr oral 1mg |
39 |
38 |
$209.38 |
| 84550 |
|
29 |
27 |
$124.13 |
| J0670 |
Inj mepivacaine hcl/10 ml |
38 |
38 |
$123.63 |
| 85027 |
|
15 |
13 |
$100.90 |
| J7613 |
Albuterol non-comp unit |
133 |
118 |
$93.82 |
| 87324 |
|
12 |
12 |
$57.04 |
| 0250R |
|
80 |
76 |
$0.00 |
| J1040 |
Methylprednisolone 80 mg inj |
14 |
14 |
$0.00 |
| 0272R |
|
99 |
99 |
$0.00 |
| 59025 |
|
131 |
57 |
$0.00 |
| 0360 |
|
20 |
12 |
$0.00 |