| Code | Description | Claims | Beneficiaries | Total Paid |
| G0463 |
Hospital outpt clinic visit |
351,716 |
322,677 |
$20.16M |
| X4011 |
|
33,321 |
30,869 |
$9.91M |
| Y7506 |
|
11,733 |
8,196 |
$9.63M |
| 99283 |
|
51,217 |
49,159 |
$8.37M |
| 85025 |
|
110,962 |
94,896 |
$7.96M |
| X4003 |
|
119,984 |
108,466 |
$7.81M |
| 99284 |
|
30,196 |
28,882 |
$6.73M |
| 99285 |
|
20,938 |
19,375 |
$5.53M |
| 80053 |
|
87,916 |
76,930 |
$4.89M |
| G0378 |
Hospital observation per hr |
7,649 |
6,647 |
$3.85M |
| X4006 |
|
6,851 |
5,434 |
$2.97M |
| 99212 |
|
65,685 |
61,455 |
$2.78M |
| G0382 |
Lev 3 hosp type b ed visit |
25,967 |
25,494 |
$2.62M |
| 97530 |
|
7,729 |
2,953 |
$2.59M |
| G0383 |
Lev 4 hosp type b ed visit |
18,437 |
18,100 |
$2.46M |
| 93005 |
|
24,636 |
22,623 |
$1.89M |
| 97112 |
|
2,642 |
770 |
$1.89M |
| 96374 |
|
15,995 |
15,184 |
$1.80M |
| 87804 |
|
12,795 |
7,542 |
$1.74M |
| 81001 |
|
13,643 |
12,858 |
$1.64M |
| 76816 |
|
10,785 |
9,434 |
$1.48M |
| 69436 |
|
847 |
833 |
$1.19M |
| 76811 |
|
6,601 |
6,221 |
$1.13M |
| 76818 |
|
6,502 |
4,300 |
$1.05M |
| 97110 |
|
1,827 |
558 |
$992K |
| 88304 |
|
493 |
402 |
$854K |
| 92507 |
|
3,185 |
1,248 |
$703K |
| 99282 |
|
7,638 |
7,500 |
$695K |
| 87880 |
|
10,347 |
10,163 |
$680K |
| 93325 |
|
1,443 |
1,302 |
$622K |
| 71046 |
|
5,237 |
4,999 |
$619K |
| J3490 |
Drugs unclassified injection |
5,478 |
3,349 |
$530K |
| 99214 |
|
4,526 |
4,448 |
$496K |
| 59025 |
|
3,055 |
2,525 |
$468K |
| 99213 |
|
6,215 |
6,052 |
$462K |
| 96413 |
|
2,729 |
1,613 |
$450K |
| 90791 |
|
4,383 |
3,901 |
$437K |
| 84703 |
|
1,517 |
1,470 |
$415K |
| 76820 |
|
2,025 |
1,241 |
$381K |
| 84443 |
|
8,002 |
7,660 |
$350K |
| 88305 |
|
3,341 |
2,289 |
$337K |
| 87428 |
|
15,645 |
15,391 |
$332K |
| U0003 |
Cov-19 amp prb hgh thruput |
13,497 |
12,597 |
$328K |
| 92567 |
|
8,334 |
8,117 |
$319K |
| 87081 |
|
5,100 |
5,033 |
$317K |
| 84484 |
|
8,129 |
6,735 |
$309K |
| J0585 |
Injection,onabotulinumtoxina |
953 |
667 |
$308K |
| 97535 |
|
535 |
235 |
$301K |
| 99211 |
|
17,770 |
17,144 |
$291K |
| 42820 |
|
121 |
120 |
$290K |
| 84439 |
|
5,429 |
5,251 |
$286K |
| 96375 |
|
7,179 |
6,065 |
$278K |
| 93321 |
|
460 |
450 |
$275K |
| 83690 |
|
3,590 |
3,319 |
$247K |
| 76819 |
|
3,503 |
2,650 |
$243K |
| 43239 |
|
619 |
586 |
$234K |
| 94060 |
|
1,295 |
1,228 |
$217K |
| 83036 |
|
6,228 |
6,061 |
$208K |
| 67028 |
|
1,387 |
1,254 |
$187K |
| 81003 |
|
5,598 |
5,235 |
$182K |
| 94010 |
|
1,683 |
1,653 |
$181K |
| 76770 |
|
1,636 |
1,578 |
$179K |
| 73630 |
|
4,381 |
4,038 |
$174K |
| 96361 |
|
5,076 |
4,065 |
$172K |
| 80307 |
|
2,513 |
2,189 |
$168K |
| 72082 |
|
1,964 |
1,905 |
$167K |
| 87086 |
|
2,532 |
2,327 |
$166K |
| J7030 |
Normal saline solution infus |
7,642 |
6,106 |
$158K |
| A0425 |
Ground mileage |
5,425 |
4,394 |
$158K |
| 92060 |
|
5,497 |
5,410 |
$153K |
| 93306 |
|
619 |
583 |
$144K |
| 92134 |
|
6,063 |
5,523 |
$142K |
| A0429 |
Bls-emergency |
2,769 |
2,203 |
$138K |
| 92579 |
|
1,257 |
1,251 |
$131K |
| 76000 |
|
42 |
39 |
$125K |
| 74177 |
|
727 |
678 |
$124K |
| 87426 |
|
6,405 |
5,731 |
$119K |
| A9552 |
F18 fdg |
310 |
184 |
$113K |
| 82306 |
|
3,082 |
2,988 |
$113K |
| 74018 |
|
1,728 |
1,638 |
$111K |
| C9803 |
Hopd covid-19 spec collect |
12,941 |
12,284 |
$109K |
| 90834 |
|
1,265 |
768 |
$104K |
| A0427 |
Als1-emergency |
1,889 |
1,685 |
$103K |
| 85610 |
|
3,256 |
2,967 |
$103K |
| G0483 |
Drug test def 22+ classes |
512 |
448 |
$103K |
| 94640 |
|
82 |
61 |
$99K |
| 93303 |
|
587 |
539 |
$97K |
| G0384 |
Lev 5 hosp type b ed visit |
516 |
506 |
$96K |
| 71045 |
|
3,001 |
2,626 |
$95K |
| J0475 |
Baclofen 10 mg injection |
237 |
224 |
$93K |
| 95816 |
|
307 |
304 |
$92K |
| 93304 |
|
188 |
172 |
$90K |
| 76813 |
|
1,053 |
922 |
$89K |
| 87635 |
|
2,420 |
2,292 |
$87K |
| 85652 |
|
1,171 |
1,112 |
$85K |
| 64642 |
|
272 |
260 |
$84K |
| 82728 |
|
3,050 |
2,924 |
$81K |
| 76830 |
|
1,424 |
1,385 |
$80K |
| 77072 |
|
713 |
698 |
$79K |
| 70553 |
|
485 |
439 |
$78K |
| 54161 |
|
56 |
56 |
$76K |
| 86900 |
|
1,569 |
1,473 |
$75K |
| 96365 |
|
699 |
621 |
$74K |
| 80061 |
|
3,325 |
3,173 |
$74K |
| J2405 |
Ondansetron hcl injection |
1,332 |
1,141 |
$72K |
| U0005 |
Infec agen detec ampli probe |
10,159 |
9,399 |
$72K |
| 73610 |
|
700 |
643 |
$70K |
| 82607 |
|
2,373 |
2,307 |
$69K |
| 83970 |
|
1,955 |
1,908 |
$68K |
| 83550 |
|
2,236 |
2,168 |
$68K |
| 77386 |
|
233 |
37 |
$66K |
| 83540 |
|
2,263 |
2,193 |
$66K |
| J2704 |
Inj, propofol, 10 mg |
1,884 |
1,613 |
$62K |
| 85730 |
|
707 |
618 |
$61K |
| G0381 |
Lev 2 hosp type b ed visit |
1,063 |
1,044 |
$61K |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
2,394 |
1,889 |
$61K |
| 85046 |
|
839 |
787 |
$59K |
| J1100 |
Dexamethasone sodium phos |
689 |
644 |
$57K |
| 92083 |
|
1,130 |
1,065 |
$54K |
| 86850 |
|
2,168 |
2,031 |
$54K |
| 83520 |
|
246 |
240 |
$53K |
| 62370 |
|
728 |
692 |
$53K |
| 90792 |
|
526 |
481 |
$52K |
| 86003 |
|
1,769 |
789 |
$52K |
| 36591 |
|
4,079 |
2,742 |
$52K |
| 76817 |
|
509 |
435 |
$52K |
| 84305 |
|
369 |
360 |
$52K |
| 92557 |
|
750 |
723 |
$50K |
| 82397 |
|
427 |
262 |
$49K |
| 20611 |
|
407 |
381 |
$48K |
| 72100 |
|
1,175 |
1,146 |
$48K |
| 77336 |
|
656 |
384 |
$47K |
| 86140 |
|
435 |
406 |
$47K |
| 99281 |
|
443 |
440 |
$46K |
| J3010 |
Fentanyl citrate injection |
1,110 |
992 |
$45K |
| A4216 |
Sterile water/saline, 10 ml |
1,993 |
1,540 |
$42K |
| 92523 |
|
344 |
340 |
$42K |
| 84425 |
|
1,583 |
1,553 |
$41K |
| 87807 |
|
414 |
400 |
$40K |
| 77067 |
|
435 |
428 |
$37K |
| 73030 |
|
1,164 |
1,077 |
$36K |
| 86901 |
|
1,569 |
1,474 |
$36K |
| 84630 |
|
1,523 |
1,489 |
$34K |
| 64615 |
|
524 |
478 |
$34K |
| 83735 |
|
2,554 |
2,427 |
$34K |
| 86255 |
|
320 |
298 |
$33K |
| 73564 |
|
604 |
557 |
$33K |
| J1885 |
Ketorolac tromethamine inj |
2,549 |
2,293 |
$32K |
| 84100 |
|
2,098 |
2,033 |
$30K |
| 87522 |
Neg quan hep c or qual rna |
586 |
559 |
$29K |
| 74183 |
|
165 |
147 |
$28K |
| 76825 |
|
86 |
84 |
$27K |
| 92133 |
|
915 |
872 |
$27K |
| 92015 |
|
2,587 |
2,464 |
$26K |
| 82747 |
|
327 |
316 |
$26K |
| 93320 |
|
328 |
282 |
$26K |
| 87651 |
|
1,292 |
1,275 |
$25K |
| 97166 |
|
406 |
397 |
$25K |
| 72148 |
|
200 |
185 |
$25K |
| 84702 |
|
126 |
125 |
$24K |
| 51705 |
|
221 |
197 |
$24K |
| 86376 |
|
414 |
396 |
$23K |
| 86800 |
|
376 |
360 |
$23K |
| J0586 |
Abobotulinumtoxina |
16 |
16 |
$23K |
| 97597 |
|
344 |
260 |
$23K |
| 86706 |
|
699 |
665 |
$22K |
| J0131 |
Inj, acetaminophen (nos) |
173 |
170 |
$22K |
| 96372 |
|
588 |
519 |
$21K |
| 86708 |
|
720 |
682 |
$21K |
| Q3014 |
Telehealth facility fee |
1,841 |
1,750 |
$21K |
| 70450 |
|
351 |
307 |
$21K |
| J2270 |
Morphine sulfate injection |
172 |
161 |
$21K |
| 86780 |
|
1,490 |
1,399 |
$20K |
| 67311 |
|
14 |
14 |
$20K |
| 97162 |
|
389 |
382 |
$20K |
| 90837 |
|
324 |
227 |
$20K |
| 73501 |
|
550 |
516 |
$19K |
| 80081 |
|
178 |
174 |
$19K |
| 66984 |
|
35 |
26 |
$19K |
| 95886 |
|
309 |
295 |
$19K |
| 90471 |
|
504 |
488 |
$19K |
| 73562 |
|
613 |
590 |
$19K |
| 87653 |
|
263 |
254 |
$18K |
| 84163 |
|
122 |
121 |
$18K |
| 76827 |
|
85 |
84 |
$17K |
| 82785 |
|
824 |
790 |
$17K |
| 83880 |
|
644 |
592 |
$17K |
| 87536 |
|
312 |
294 |
$17K |
| 31575 |
|
244 |
237 |
$16K |
| 51798 |
|
632 |
586 |
$15K |
| 70551 |
|
39 |
37 |
$15K |
| 72170 |
|
198 |
188 |
$14K |
| 95004 |
|
84 |
83 |
$14K |
| 77063 |
|
417 |
410 |
$14K |
| 86704 |
|
240 |
227 |
$14K |
| 82105 |
|
970 |
917 |
$14K |
| 99203 |
|
145 |
145 |
$13K |
| J1642 |
Inj heparin sodium per 10 u |
1,234 |
694 |
$13K |
| 87591 |
|
189 |
164 |
$13K |
| A9577 |
Inj multihance |
165 |
145 |
$13K |
| 87491 |
|
172 |
149 |
$13K |
| 64635 |
|
17 |
14 |
$13K |
| 87661 |
|
214 |
200 |
$12K |
| 29075 |
|
68 |
53 |
$12K |
| 82746 |
|
1,381 |
1,355 |
$12K |
| 98941 |
|
984 |
416 |
$12K |
| 70360 |
|
53 |
53 |
$12K |
| 99392 |
|
134 |
134 |
$12K |
| 76815 |
|
228 |
162 |
$12K |
| 45380 |
|
38 |
38 |
$12K |
| 82962 |
|
1,484 |
788 |
$12K |
| G2066 |
Inter devc remote 30d |
755 |
734 |
$12K |
| 87389 |
|
585 |
556 |
$12K |
| G0480 |
Drug test def 1-7 classes |
204 |
171 |
$11K |
| 99204 |
|
85 |
85 |
$11K |
| 92004 |
|
416 |
415 |
$11K |
| 93922 |
|
263 |
250 |
$11K |
| 85027 |
|
1,037 |
937 |
$11K |
| G0260 |
Inj for sacroiliac jt anesth |
63 |
55 |
$11K |
| 88307 |
|
103 |
103 |
$10K |
| 93296 |
|
777 |
750 |
$10K |
| 92014 |
|
989 |
942 |
$10K |
| 20610 |
|
98 |
92 |
$10K |
| 92552 |
|
96 |
94 |
$10K |
| J2469 |
Palonosetron hcl |
94 |
63 |
$10K |
| 41899 |
|
101 |
90 |
$10K |
| 71260 |
|
118 |
100 |
$9K |
| 91200 |
|
233 |
200 |
$9K |
| 17311 |
|
29 |
25 |
$9K |
| 76801 |
|
136 |
124 |
$8K |
| 92504 |
|
360 |
311 |
$8K |
| 95910 |
|
45 |
43 |
$8K |
| 82172 |
|
91 |
89 |
$8K |
| 76700 |
|
140 |
138 |
$8K |
| 83883 |
|
91 |
89 |
$8K |
| 83010 |
|
91 |
89 |
$8K |
| 87430 |
|
15 |
15 |
$7K |
| 82977 |
|
91 |
89 |
$7K |
| A9585 |
Gadobutrol injection |
190 |
161 |
$7K |
| C7901 |
Hopd mntl hlt, 30-60 min |
169 |
168 |
$7K |
| 99391 |
|
86 |
81 |
$7K |
| 64643 |
|
44 |
40 |
$7K |
| 62321 |
|
25 |
25 |
$7K |
| Q9957 |
Inj perflutren lip micros,ml |
82 |
73 |
$7K |
| 0002A |
|
462 |
409 |
$7K |
| 87902 |
|
30 |
29 |
$7K |
| 92020 |
|
111 |
102 |
$7K |
| 82533 |
|
28 |
28 |
$7K |
| 77073 |
|
82 |
80 |
$7K |
| 73130 |
|
112 |
101 |
$6K |
| 80074 |
|
66 |
63 |
$6K |
| 84446 |
|
655 |
650 |
$6K |
| 87210 |
|
14 |
14 |
$6K |
| 84597 |
|
659 |
654 |
$6K |
| 82950 |
|
242 |
235 |
$6K |
| 0001A |
|
479 |
414 |
$6K |
| A0428 |
Bls |
198 |
152 |
$6K |
| 73100 |
|
45 |
39 |
$6K |
| 86709 |
|
116 |
109 |
$6K |
| 76805 |
|
97 |
90 |
$6K |
| 17110 |
|
54 |
54 |
$6K |
| 84590 |
|
672 |
667 |
$6K |
| 87340 |
|
467 |
446 |
$6K |
| 96130 |
|
27 |
26 |
$6K |
| 74176 |
|
50 |
42 |
$5K |
| 96112 |
|
53 |
50 |
$5K |
| 82525 |
|
611 |
606 |
$5K |
| 72141 |
|
49 |
42 |
$5K |
| 96415 |
|
193 |
112 |
$5K |
| 90480 |
|
282 |
280 |
$5K |
| 96411 |
|
209 |
130 |
$5K |
| 73560 |
|
152 |
137 |
$5K |
| 92285 |
|
223 |
205 |
$5K |
| 73110 |
|
98 |
88 |
$5K |
| D9420 |
|
78 |
78 |
$5K |
| 77417 |
|
29 |
12 |
$5K |
| 72110 |
|
114 |
111 |
$5K |
| 93010 |
|
570 |
507 |
$5K |
| J3301 |
Triamcinolone acet inj nos |
617 |
579 |
$5K |
| 92136 |
|
83 |
80 |
$5K |
| 86364 |
|
635 |
382 |
$4K |
| 90686 |
|
601 |
600 |
$4K |
| 73721 |
|
40 |
38 |
$4K |
| 72040 |
|
117 |
113 |
$4K |
| 96360 |
|
29 |
26 |
$4K |
| 92235 |
|
43 |
39 |
$4K |
| C7900 |
Hopd mntl hlt, 15-29 min |
226 |
225 |
$4K |
| 99393 |
|
43 |
43 |
$4K |
| 83002 |
|
15 |
13 |
$4K |
| 83001 |
|
14 |
12 |
$4K |
| 83615 |
|
211 |
176 |
$4K |
| 96417 |
|
138 |
90 |
$3K |
| 86258 |
|
528 |
292 |
$3K |
| 98940 |
|
409 |
215 |
$3K |
| 52000 |
|
25 |
25 |
$3K |
| J7120 |
Ringers lactate infusion |
357 |
286 |
$3K |
| 86592 |
|
26 |
26 |
$3K |
| 88312 |
|
32 |
28 |
$3K |
| 81596 |
|
18 |
17 |
$3K |
| 80305 |
|
136 |
129 |
$3K |
| 87801 |
|
118 |
112 |
$3K |
| 88142 |
|
78 |
75 |
$3K |
| 92226 |
|
434 |
355 |
$3K |
| 96366 |
|
96 |
78 |
$3K |
| 80076 |
|
185 |
178 |
$3K |
| 86762 |
|
335 |
320 |
$3K |
| 92025 |
|
106 |
99 |
$3K |
| 62323 |
|
12 |
12 |
$3K |
| 82805 |
|
61 |
59 |
$3K |
| 83525 |
|
14 |
14 |
$3K |
| 82784 |
|
665 |
619 |
$3K |
| 80048 |
|
396 |
342 |
$3K |
| 82570 |
|
443 |
413 |
$3K |
| 83516 |
|
93 |
80 |
$3K |
| 84550 |
|
14 |
14 |
$2K |
| 86304 |
|
221 |
181 |
$2K |
| 95908 |
|
19 |
17 |
$2K |
| J2250 |
Inj midazolam hydrochloride |
337 |
274 |
$2K |
| 31579 |
|
12 |
12 |
$2K |
| 84156 |
|
379 |
356 |
$2K |
| 82378 |
|
187 |
134 |
$2K |
| 92556 |
|
27 |
25 |
$2K |
| J7040 |
Normal saline solution infus |
247 |
142 |
$2K |
| 86231 |
|
309 |
294 |
$2K |
| J1050 |
Medroxyprogesterone acetate |
34 |
34 |
$2K |
| 83605 |
|
297 |
254 |
$2K |
| 95885 |
|
13 |
12 |
$2K |
| 0124A |
|
71 |
68 |
$2K |
| 11102 |
|
13 |
12 |
$2K |
| 86381 |
|
137 |
133 |
$2K |
| 87070 |
|
106 |
102 |
$1K |
| J2795 |
Ropivacaine hcl injection |
339 |
270 |
$1K |
| 69210 |
|
103 |
94 |
$1K |
| 86803 |
|
129 |
126 |
$1K |
| 87186 |
|
31 |
26 |
$1K |
| 84460 |
|
12 |
12 |
$1K |
| 82247 |
|
12 |
12 |
$1K |
| 73070 |
|
67 |
56 |
$1K |
| 71275 |
|
12 |
12 |
$1K |
| 0012A |
|
136 |
130 |
$1K |
| 86360 |
|
42 |
39 |
$1K |
| 99202 |
|
19 |
19 |
$1K |
| 0011A |
|
169 |
146 |
$1K |
| 94618 |
|
27 |
25 |
$1K |
| 99242 |
|
14 |
14 |
$1K |
| 81025 |
|
238 |
229 |
$1K |
| 86359 |
|
42 |
39 |
$957.74 |
| 83020 |
|
341 |
322 |
$950.35 |
| 0072A |
|
55 |
55 |
$880.00 |
| J0171 |
Adrenalin epinephrine inject |
27 |
13 |
$785.12 |
| X4014 |
|
43 |
43 |
$715.64 |
| 73140 |
|
12 |
12 |
$705.52 |
| 72125 |
|
12 |
12 |
$690.37 |
| 76705 |
|
13 |
13 |
$683.75 |
| 76642 |
|
15 |
13 |
$633.12 |
| 96368 |
|
17 |
12 |
$630.76 |
| 86015 |
|
111 |
105 |
$629.33 |
| 76942 |
|
13 |
12 |
$627.88 |
| 90847 |
|
15 |
12 |
$579.33 |
| 82103 |
|
89 |
82 |
$531.52 |
| 71250 |
|
13 |
12 |
$510.91 |
| 86341 |
|
32 |
32 |
$500.60 |
| 93308 |
|
13 |
13 |
$475.93 |
| 86480 |
|
14 |
14 |
$446.25 |
| 0071A |
|
212 |
208 |
$440.00 |
| 87624 |
|
13 |
12 |
$435.82 |
| J0690 |
Cefazolin sodium injection |
50 |
36 |
$377.23 |
| 11721 |
|
46 |
41 |
$293.78 |
| 80197 |
|
113 |
101 |
$288.12 |
| 80143 |
|
14 |
12 |
$281.92 |
| 80179 |
|
14 |
12 |
$281.92 |
| J1170 |
Hydromorphone injection |
40 |
28 |
$277.12 |
| 82390 |
|
62 |
59 |
$274.56 |
| 92201 |
|
29 |
25 |
$237.70 |
| 97804 |
|
516 |
448 |
$237.15 |
| 0001M |
|
30 |
25 |
$232.29 |
| 95250 |
|
13 |
13 |
$223.12 |
| 93297 |
|
117 |
115 |
$213.21 |
| J1644 |
Inj heparin sodium per 1000u |
42 |
25 |
$192.84 |
| 73090 |
|
13 |
13 |
$183.51 |
| J8540 |
Oral dexamethasone |
96 |
50 |
$142.79 |
| 93298 |
|
57 |
44 |
$142.11 |
| 86580 |
|
20 |
13 |
$122.83 |
| 73590 |
|
13 |
12 |
$120.23 |
| 82104 |
|
17 |
17 |
$118.34 |
| 87077 |
|
49 |
38 |
$114.59 |
| 82077 |
|
13 |
12 |
$111.88 |
| 85018 |
|
74 |
72 |
$105.95 |
| 95874 |
|
146 |
135 |
$105.80 |
| 90670 |
|
14 |
14 |
$104.86 |
| 84481 |
|
13 |
13 |
$103.70 |
| 86008 |
|
13 |
12 |
$93.60 |
| 27096 |
|
35 |
24 |
$86.19 |
| 36415 |
|
50 |
43 |
$52.72 |
| 76514 |
|
31 |
28 |
$46.93 |
| 80069 |
|
14 |
12 |
$46.86 |
| 84238 |
|
14 |
13 |
$29.25 |
| 82379 |
|
12 |
12 |
$26.98 |
| 84403 |
|
12 |
12 |
$20.64 |
| 84402 |
|
12 |
12 |
$20.37 |
| 82043 |
|
13 |
13 |
$16.64 |
| 96376 |
|
1,029 |
678 |
$14.66 |
| 90472 |
|
12 |
12 |
$13.30 |
| J0665 |
Inj, bupivacaine, nos, 0.5mg |
15 |
12 |
$1.54 |
| G0008 |
Admin influenza virus vac |
45 |
45 |
$0.00 |
| V2632 |
Post chmbr intraocular lens |
15 |
13 |
$0.00 |
| 46600 |
|
13 |
13 |
$0.00 |
| 00000 |
|
45 |
25 |
$0.00 |
| J7050 |
Normal saline solution infus |
42 |
25 |
$0.00 |
| D7999 |
|
13 |
13 |
$0.00 |
| 91320 |
|
27 |
27 |
$0.00 |
| 84207 |
|
12 |
12 |
$0.00 |
| C1776 |
Joint device (implantable) |
20 |
16 |
$0.00 |