| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 0450 |
|
108,272 |
92,579 |
$24.25M |
| 74177 |
|
17,260 |
16,618 |
$6.80M |
| J9271 |
Inj pembrolizumab |
669 |
538 |
$5.89M |
| 99283 |
|
22,600 |
19,517 |
$4.93M |
| 87636 |
|
26,102 |
24,565 |
$4.82M |
| 99202 |
|
60,513 |
46,781 |
$4.78M |
| 99285 |
|
2,004 |
1,879 |
$4.44M |
| 0121 |
|
635 |
511 |
$4.33M |
| 99199 |
|
65,644 |
49,054 |
$4.23M |
| 70450 |
|
13,006 |
12,496 |
$3.78M |
| 77386 |
|
7,086 |
660 |
$3.63M |
| G0463 |
Hospital outpt clinic visit |
68,026 |
58,328 |
$3.27M |
| 99284 |
|
2,267 |
2,081 |
$3.02M |
| 96374 |
|
33,446 |
29,095 |
$2.98M |
| 72125 |
|
6,262 |
6,037 |
$2.91M |
| 96365 |
|
18,027 |
13,826 |
$2.67M |
| 93005 |
|
56,837 |
48,838 |
$2.40M |
| 99201 |
|
30,592 |
23,606 |
$2.39M |
| 80053 |
|
105,981 |
87,854 |
$2.38M |
| 71260 |
|
6,954 |
6,704 |
$2.36M |
| 96375 |
|
32,717 |
25,024 |
$2.36M |
| 96361 |
|
27,186 |
21,645 |
$2.34M |
| Z7500 |
|
63,606 |
54,600 |
$2.14M |
| J0585 |
Injection,onabotulinumtoxina |
1,983 |
1,549 |
$1.98M |
| 70553 |
|
3,627 |
3,549 |
$1.89M |
| 90791 |
|
9,362 |
8,441 |
$1.85M |
| 96366 |
|
7,984 |
5,566 |
$1.84M |
| J3490 |
Drugs unclassified injection |
92,536 |
54,928 |
$1.76M |
| 85025 |
|
151,260 |
122,579 |
$1.66M |
| J1561 |
Gamunex-c/gammaked |
1,537 |
456 |
$1.44M |
| 93306 |
|
5,682 |
5,598 |
$1.42M |
| 78815 |
|
1,061 |
1,034 |
$1.40M |
| 0510 |
|
32,653 |
28,635 |
$1.33M |
| G0480 |
Drug test def 1-7 classes |
13,539 |
12,743 |
$1.26M |
| 71046 |
|
25,268 |
23,904 |
$1.15M |
| 99499 |
|
12,352 |
8,697 |
$1.14M |
| J1745 |
Infliximab not biosimil 10mg |
550 |
495 |
$1.13M |
| 96360 |
|
11,408 |
8,884 |
$1.06M |
| 87389 |
|
30,863 |
30,079 |
$1.06M |
| 80048 |
|
60,106 |
50,265 |
$925K |
| 96413 |
|
12,662 |
8,193 |
$910K |
| J9299 |
Injection, nivolumab |
111 |
77 |
$901K |
| 99281 |
|
10,538 |
9,401 |
$895K |
| 70551 |
|
2,165 |
2,130 |
$875K |
| 71045 |
|
19,361 |
18,227 |
$868K |
| C9803 |
Hopd covid-19 spec collect |
27,323 |
25,593 |
$811K |
| 70486 |
|
2,555 |
2,503 |
$804K |
| 86803 |
|
30,508 |
29,941 |
$785K |
| 87635 |
|
14,484 |
13,645 |
$771K |
| 71275 |
|
2,129 |
2,092 |
$728K |
| 96372 |
|
17,514 |
13,478 |
$691K |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
19,761 |
18,512 |
$670K |
| 93325 |
|
4,719 |
4,590 |
$666K |
| 73564 |
|
6,633 |
5,740 |
$642K |
| 83690 |
|
42,853 |
39,316 |
$627K |
| 70498 |
|
1,171 |
1,141 |
$586K |
| J7050 |
Normal saline solution infus |
19,903 |
11,926 |
$566K |
| 76705 |
|
5,601 |
5,337 |
$538K |
| 93303 |
|
2,461 |
2,430 |
$532K |
| Q5104 |
Injection, renflexis |
471 |
424 |
$521K |
| 0762 |
|
1,438 |
802 |
$520K |
| 0761 |
|
8,947 |
7,120 |
$508K |
| 72148 |
|
1,307 |
1,291 |
$475K |
| 0760 |
|
75,033 |
56,511 |
$466K |
| 82248 |
|
51,568 |
46,890 |
$465K |
| Z7502 |
|
12,270 |
11,593 |
$463K |
| 72141 |
|
1,015 |
998 |
$454K |
| 84484 |
|
25,685 |
19,159 |
$453K |
| 73610 |
|
7,195 |
6,286 |
$452K |
| 93970 |
|
1,957 |
1,923 |
$450K |
| J2350 |
Injection, ocrelizumab, 1 mg |
26 |
24 |
$449K |
| P9016 |
Rbc leukocytes reduced |
934 |
811 |
$443K |
| 87637 |
|
2,190 |
2,106 |
$427K |
| 70496 |
|
1,094 |
1,059 |
$427K |
| 76825 |
|
1,186 |
1,107 |
$412K |
| 74176 |
|
2,052 |
1,984 |
$411K |
| 87591 |
|
8,300 |
7,931 |
$406K |
| 73110 |
|
6,640 |
5,460 |
$399K |
| 73080 |
|
5,094 |
4,530 |
$380K |
| 83880 |
|
11,738 |
10,124 |
$376K |
| 82805 |
|
6,585 |
6,027 |
$366K |
| 99282 |
|
859 |
813 |
$361K |
| 73630 |
|
7,584 |
6,670 |
$359K |
| 73130 |
|
6,806 |
5,753 |
$357K |
| 73030 |
|
5,033 |
4,503 |
$342K |
| 73590 |
|
6,149 |
5,379 |
$341K |
| 76856 |
|
3,749 |
3,647 |
$335K |
| 87491 |
|
8,316 |
7,945 |
$328K |
| 88305 |
|
13,950 |
10,967 |
$325K |
| A9552 |
F18 fdg |
1,229 |
1,210 |
$307K |
| 76770 |
|
3,195 |
3,120 |
$307K |
| 88185 |
|
603 |
484 |
$307K |
| 93971 |
|
2,210 |
2,138 |
$307K |
| 94640 |
|
9,632 |
5,754 |
$305K |
| J0131 |
Inj, acetaminophen (nos) |
5,537 |
4,475 |
$298K |
| 0360 |
|
1,913 |
1,444 |
$295K |
| 0270 |
|
2,424 |
1,823 |
$276K |
| 86850 |
|
23,590 |
19,407 |
$276K |
| 84443 |
|
15,472 |
14,984 |
$270K |
| 93975 |
|
954 |
935 |
$269K |
| 73090 |
|
5,016 |
4,238 |
$262K |
| 70491 |
|
1,029 |
1,000 |
$261K |
| 70487 |
|
763 |
749 |
$259K |
| 0370 |
|
411 |
395 |
$258K |
| 76830 |
|
2,475 |
2,415 |
$255K |
| 93320 |
|
2,618 |
2,577 |
$250K |
| 0160 |
|
3,916 |
2,358 |
$248K |
| 86900 |
|
24,380 |
20,006 |
$241K |
| 88341 |
|
1,327 |
980 |
$237K |
| J0185 |
Inj., aprepitant, 1 mg |
1,402 |
887 |
$236K |
| 0710 |
|
2,647 |
2,565 |
$230K |
| 96415 |
|
4,000 |
2,964 |
$228K |
| Z7506 |
|
1,750 |
1,717 |
$227K |
| 83735 |
|
28,539 |
20,526 |
$225K |
| J7040 |
Normal saline solution infus |
5,409 |
4,277 |
$222K |
| 87502 |
|
1,914 |
1,873 |
$221K |
| 85027 |
|
23,801 |
19,201 |
$219K |
| 76816 |
|
3,366 |
2,669 |
$215K |
| 73700 |
|
723 |
687 |
$202K |
| J2405 |
Ondansetron hcl injection |
25,296 |
19,924 |
$200K |
| 96367 |
|
3,602 |
2,582 |
$196K |
| Q4051 |
Splint supplies misc |
65 |
50 |
$195K |
| 76815 |
|
2,953 |
2,304 |
$194K |
| 73060 |
|
2,787 |
2,549 |
$190K |
| J0897 |
Denosumab injection |
203 |
196 |
$189K |
| 90715 |
|
4,187 |
4,110 |
$188K |
| J3380 |
Inj vedolizumab iv 1 mg |
56 |
52 |
$184K |
| 87086 |
|
15,607 |
14,515 |
$181K |
| 84702 |
|
2,797 |
2,384 |
$181K |
| J0696 |
Ceftriaxone sodium injection |
7,060 |
6,283 |
$176K |
| G0378 |
Hospital observation per hr |
2,627 |
2,225 |
$175K |
| 73502 |
|
3,072 |
2,862 |
$169K |
| 83605 |
|
9,390 |
8,052 |
$168K |
| 82306 |
|
8,240 |
8,124 |
$167K |
| 43239 |
|
1,609 |
1,602 |
$166K |
| 77336 |
|
2,597 |
1,182 |
$164K |
| 77334 |
|
564 |
400 |
$158K |
| 74018 |
|
3,663 |
3,385 |
$156K |
| 76700 |
|
1,753 |
1,729 |
$153K |
| 71250 |
|
832 |
822 |
$153K |
| J0485 |
Belatacept injection |
239 |
139 |
$150K |
| 72156 |
|
239 |
237 |
$146K |
| 81001 |
|
23,712 |
21,829 |
$146K |
| 87651 |
|
2,795 |
2,713 |
$144K |
| 74183 |
|
631 |
623 |
$144K |
| Q5107 |
Inj mvasi 10 mg |
101 |
37 |
$139K |
| 0301 |
|
786 |
738 |
$137K |
| 82803 |
|
4,271 |
3,926 |
$135K |
| 86901 |
|
24,542 |
20,084 |
$131K |
| 87522 |
Neg quan hep c or qual rna |
2,068 |
2,009 |
$131K |
| 72100 |
|
2,685 |
2,630 |
$128K |
| 82962 |
|
22,885 |
17,407 |
$128K |
| 76801 |
|
1,476 |
1,367 |
$127K |
| 83036 |
|
15,169 |
14,792 |
$127K |
| 76827 |
|
1,176 |
1,099 |
$124K |
| J1170 |
Hydromorphone injection |
10,535 |
8,132 |
$124K |
| J1885 |
Ketorolac tromethamine inj |
16,587 |
14,833 |
$123K |
| 0636 |
|
613 |
570 |
$123K |
| J1815 |
Insulin injection |
2,780 |
1,718 |
$122K |
| 73552 |
|
3,481 |
3,132 |
$120K |
| 72082 |
|
1,989 |
1,965 |
$118K |
| 86923 |
|
1,487 |
927 |
$116K |
| 77301 |
|
98 |
97 |
$114K |
| J0178 |
Aflibercept injection |
62 |
61 |
$113K |
| 96417 |
|
2,275 |
1,510 |
$111K |
| 86140 |
|
14,057 |
13,239 |
$111K |
| 76870 |
|
1,139 |
1,099 |
$110K |
| 87040 |
|
5,331 |
3,917 |
$109K |
| 0460 |
|
1,835 |
1,599 |
$109K |
| Z9725 |
|
2,475 |
2,453 |
$106K |
| 94010 |
|
2,880 |
2,858 |
$105K |
| J2704 |
Inj, propofol, 10 mg |
9,025 |
6,650 |
$104K |
| 81025 |
|
13,344 |
12,587 |
$101K |
| J2930 |
Methylprednisolone injection |
2,251 |
1,577 |
$100K |
| 85610 |
|
20,790 |
17,751 |
$99K |
| 77300 |
|
362 |
338 |
$98K |
| 85730 |
|
8,437 |
7,943 |
$96K |
| 86780 |
|
7,683 |
7,379 |
$95K |
| 94618 |
|
1,103 |
1,086 |
$92K |
| 72070 |
|
996 |
955 |
$91K |
| 96409 |
|
2,763 |
1,487 |
$90K |
| 72040 |
|
1,521 |
1,470 |
$90K |
| 95782 |
|
78 |
78 |
$86K |
| 92504 |
|
2,826 |
2,706 |
$86K |
| A9579 |
Gad-base mr contrast nos,1ml |
4,258 |
4,089 |
$83K |
| 0250 |
|
1,381 |
1,200 |
$83K |
| 76536 |
|
1,472 |
1,435 |
$82K |
| 0700 |
|
1,265 |
1,143 |
$82K |
| 92557 |
|
1,193 |
1,173 |
$82K |
| U0003 |
Cov-19 amp prb hgh thruput |
1,271 |
1,233 |
$80K |
| 86003 |
|
730 |
678 |
$80K |
| 84100 |
|
16,064 |
12,531 |
$78K |
| 74174 |
|
241 |
237 |
$76K |
| J3010 |
Fentanyl citrate injection |
15,157 |
12,814 |
$75K |
| 87077 |
|
6,089 |
5,839 |
$75K |
| 86922 |
|
1,011 |
638 |
$75K |
| J2270 |
Morphine sulfate injection |
5,422 |
4,628 |
$74K |
| 87799 |
|
1,608 |
1,251 |
$74K |
| 88342 |
|
2,422 |
2,226 |
$74K |
| J3475 |
Inj magnesium sulfate |
4,954 |
3,118 |
$73K |
| 76857 |
|
1,096 |
1,075 |
$73K |
| 83970 |
|
2,363 |
2,302 |
$72K |
| 76811 |
|
592 |
590 |
$71K |
| 85652 |
|
11,546 |
10,922 |
$71K |
| J8499 |
Oral prescrip drug non chemo |
8,906 |
3,755 |
$71K |
| J7120 |
Ringers lactate infusion |
5,717 |
5,198 |
$70K |
| Z7514 |
|
1,245 |
674 |
$70K |
| J0780 |
Prochlorperazine injection |
2,989 |
2,671 |
$70K |
| 81003 |
|
16,915 |
16,014 |
$69K |
| 72197 |
|
275 |
274 |
$69K |
| 85379 |
|
3,778 |
3,583 |
$67K |
| 84439 |
|
7,128 |
6,923 |
$61K |
| 72157 |
|
109 |
107 |
$61K |
| 87633 |
|
118 |
117 |
$60K |
| J2250 |
Inj midazolam hydrochloride |
12,248 |
11,069 |
$60K |
| 90471 |
|
2,465 |
2,290 |
$60K |
| 73721 |
|
278 |
261 |
$59K |
| J0875 |
Injection, dalbavancin |
13 |
13 |
$59K |
| 87186 |
|
4,300 |
4,124 |
$59K |
| 87631 |
|
657 |
629 |
$58K |
| 95816 |
|
618 |
614 |
$58K |
| 86480 |
|
1,453 |
1,430 |
$55K |
| 95004 |
|
97 |
94 |
$54K |
| 36415 |
|
7,747 |
6,642 |
$53K |
| J3370 |
Vancomycin hcl injection |
1,890 |
1,407 |
$52K |
| 97750 |
|
1,049 |
906 |
$52K |
| 45380 |
|
599 |
595 |
$52K |
| 72158 |
|
68 |
68 |
$52K |
| 96411 |
|
673 |
457 |
$51K |
| 82784 |
|
3,878 |
3,394 |
$49K |
| 72146 |
|
121 |
121 |
$49K |
| 72131 |
|
158 |
158 |
$49K |
| 87493 |
|
1,172 |
1,148 |
$48K |
| 77295 |
|
40 |
26 |
$48K |
| Q5119 |
Inj ruxience, 10 mg |
26 |
16 |
$47K |
| J1200 |
Diphenhydramine hcl injectio |
7,951 |
5,964 |
$47K |
| 72170 |
|
871 |
841 |
$47K |
| 93226 |
|
731 |
726 |
$47K |
| 76512 |
|
709 |
568 |
$47K |
| 80197 |
|
3,960 |
2,592 |
$46K |
| J3590 |
Unclassified biologics |
331 |
232 |
$46K |
| J1100 |
Dexamethasone sodium phos |
7,344 |
5,485 |
$46K |
| 87081 |
|
4,100 |
3,651 |
$46K |
| A4649 |
Surgical supplies |
1,078 |
1,026 |
$46K |
| Z7512 |
|
1,774 |
1,746 |
$45K |
| 80061 |
|
6,073 |
5,953 |
$44K |
| 96523 |
|
1,382 |
1,030 |
$44K |
| 99070 |
|
1,374 |
1,319 |
$44K |
| 83516 |
|
2,702 |
1,925 |
$43K |
| 87340 |
|
3,325 |
3,241 |
$41K |
| 81002 |
|
10,369 |
7,900 |
$39K |
| 72050 |
|
760 |
752 |
$37K |
| 87070 |
|
3,020 |
2,866 |
$37K |
| 82728 |
|
4,621 |
4,416 |
$36K |
| 88184 |
|
572 |
463 |
$36K |
| Z7508 |
|
617 |
610 |
$36K |
| 80076 |
|
2,985 |
2,839 |
$36K |
| 92567 |
|
921 |
910 |
$36K |
| A4217 |
Sterile water/saline, 500 ml |
2,216 |
1,939 |
$35K |
| 76820 |
|
374 |
303 |
$35K |
| J9267 |
Paclitaxel injection |
217 |
123 |
$34K |
| 97110 |
|
2,459 |
1,254 |
$34K |
| 94726 |
|
795 |
789 |
$34K |
| 77290 |
|
132 |
93 |
$34K |
| 82140 |
|
1,656 |
1,536 |
$33K |
| 86235 |
|
627 |
540 |
$32K |
| 82550 |
|
3,821 |
3,344 |
$32K |
| 59025 |
|
2,377 |
1,143 |
$32K |
| 81514 |
|
109 |
107 |
$31K |
| 82570 |
|
8,332 |
7,294 |
$31K |
| 80164 |
|
1,317 |
1,163 |
$31K |
| 84466 |
|
3,554 |
3,492 |
$31K |
| 80307 |
|
354 |
265 |
$31K |
| J2777 |
Inj, faricimab-svoa, 0.1mg |
12 |
12 |
$30K |
| 96368 |
|
1,030 |
682 |
$30K |
| 76817 |
|
529 |
495 |
$30K |
| J1650 |
Inj enoxaparin sodium |
1,896 |
719 |
$30K |
| 93356 |
|
808 |
805 |
$29K |
| J0690 |
Cefazolin sodium injection |
3,355 |
2,890 |
$29K |
| 93017 |
|
349 |
345 |
$29K |
| 94729 |
|
821 |
814 |
$28K |
| 77338 |
|
105 |
101 |
$28K |
| 92582 |
|
341 |
337 |
$28K |
| 72110 |
|
465 |
463 |
$28K |
| 70544 |
|
139 |
138 |
$28K |
| 87497 |
|
597 |
375 |
$27K |
| 93922 |
|
628 |
613 |
$27K |
| 96416 |
|
586 |
318 |
$26K |
| J1644 |
Inj heparin sodium per 1000u |
2,774 |
1,431 |
$26K |
| 73000 |
|
473 |
432 |
$26K |
| 0306 |
|
545 |
529 |
$25K |
| J7030 |
Normal saline solution infus |
3,524 |
2,193 |
$25K |
| J0134 |
Inj acetaminophen -fresenius |
473 |
450 |
$25K |
| 77067 |
|
968 |
963 |
$24K |
| 76942 |
|
367 |
348 |
$24K |
| 93225 |
|
497 |
494 |
$24K |
| J2060 |
Lorazepam injection |
2,888 |
2,256 |
$23K |
| 0305 |
|
692 |
654 |
$23K |
| 95886 |
|
466 |
368 |
$23K |
| 42820 |
|
124 |
123 |
$23K |
| 73562 |
|
926 |
867 |
$23K |
| 92014 |
|
564 |
561 |
$23K |
| 88108 |
|
1,288 |
1,171 |
$23K |
| 87653 |
|
907 |
894 |
$21K |
| J1953 |
Levetiracetam injection |
298 |
253 |
$21K |
| Z5924 |
|
295 |
295 |
$21K |
| 88313 |
|
885 |
503 |
$21K |
| 92552 |
|
1,065 |
1,038 |
$20K |
| J1756 |
Iron sucrose injection |
256 |
141 |
$20K |
| 73560 |
|
1,027 |
709 |
$20K |
| 86706 |
|
2,052 |
1,999 |
$20K |
| 83540 |
|
4,197 |
4,108 |
$20K |
| J7060 |
5% dextrose/water |
3,787 |
1,721 |
$19K |
| 95810 |
|
65 |
64 |
$19K |
| L8699 |
Prosthetic implant nos |
13 |
13 |
$19K |
| 82330 |
|
790 |
650 |
$19K |
| 93296 |
|
1,061 |
1,060 |
$19K |
| 84156 |
|
6,806 |
5,719 |
$18K |
| 73600 |
|
696 |
595 |
$18K |
| 94060 |
|
381 |
378 |
$18K |
| 92134 |
|
3,001 |
2,905 |
$18K |
| 96450 |
|
65 |
62 |
$18K |
| 90686 |
|
2,952 |
2,884 |
$18K |
| J9190 |
Fluorouracil injection |
1,044 |
401 |
$18K |
| 92060 |
|
1,244 |
1,215 |
$17K |
| 87205 |
|
2,873 |
2,672 |
$17K |
| 82378 |
|
1,217 |
1,135 |
$17K |
| 0750 |
|
191 |
185 |
$17K |
| 86704 |
|
1,618 |
1,577 |
$17K |
| 83615 |
|
2,972 |
2,351 |
$16K |
| 95819 |
|
207 |
206 |
$16K |
| X4301 |
|
170 |
170 |
$16K |
| 86038 |
|
1,384 |
1,367 |
$16K |
| J2785 |
Regadenoson injection |
124 |
123 |
$16K |
| J0561 |
Penicillin g benzathine inj |
32 |
29 |
$16K |
| 84703 |
|
325 |
310 |
$16K |
| 92579 |
|
286 |
282 |
$15K |
| 69436 |
|
102 |
102 |
$15K |
| 76000 |
|
357 |
351 |
$15K |
| 82746 |
|
1,306 |
1,293 |
$15K |
| J9045 |
Carboplatin injection |
460 |
292 |
$14K |
| 87624 |
|
526 |
525 |
$14K |
| 99211 |
|
529 |
439 |
$14K |
| 85007 |
|
3,588 |
2,877 |
$14K |
| P9040 |
Rbc leukoreduced irradiated |
32 |
26 |
$14K |
| 92650 |
|
43 |
42 |
$14K |
| 73140 |
|
451 |
415 |
$14K |
| 86360 |
|
369 |
363 |
$14K |
| J0475 |
Baclofen 10 mg injection |
13 |
13 |
$13K |
| 86160 |
|
757 |
729 |
$13K |
| 76642 |
|
305 |
296 |
$13K |
| U0005 |
Infec agen detec ampli probe |
891 |
856 |
$12K |
| A4216 |
Sterile water/saline, 10 ml |
1,679 |
1,014 |
$12K |
| J1790 |
Droperidol injection |
566 |
522 |
$12K |
| 92555 |
|
502 |
495 |
$12K |
| 77387 |
|
51 |
13 |
$12K |
| 85045 |
|
2,631 |
2,103 |
$12K |
| 59841 |
|
37 |
37 |
$11K |
| J3301 |
Triamcinolone acet inj nos |
1,128 |
1,079 |
$11K |
| J1630 |
Haloperidol injection |
1,460 |
1,103 |
$11K |
| 72190 |
|
267 |
254 |
$11K |
| 87507 |
|
31 |
31 |
$11K |
| J1642 |
Inj heparin sodium per 10 u |
3,774 |
1,814 |
$11K |
| 86359 |
|
371 |
366 |
$11K |
| 82607 |
|
1,515 |
1,502 |
$11K |
| 0300 |
|
660 |
626 |
$11K |
| 90670 |
|
214 |
195 |
$11K |
| 96401 |
|
535 |
277 |
$10K |
| Z7510 |
|
176 |
175 |
$10K |
| 70543 |
|
40 |
38 |
$10K |
| 82533 |
|
682 |
613 |
$10K |
| 84403 |
|
726 |
685 |
$10K |
| J3360 |
Diazepam injection |
266 |
235 |
$10K |
| 74178 |
|
54 |
53 |
$9K |
| 88307 |
|
251 |
221 |
$9K |
| 83520 |
|
615 |
589 |
$9K |
| 96379 |
|
256 |
232 |
$9K |
| 82785 |
|
558 |
552 |
$9K |
| J9370 |
Vincristine sulfate 1 mg inj |
1,036 |
742 |
$9K |
| J1940 |
Furosemide injection |
883 |
531 |
$9K |
| 88304 |
|
608 |
557 |
$8K |
| 86225 |
|
705 |
645 |
$8K |
| 92012 |
|
147 |
142 |
$8K |
| Z7610 |
|
2,139 |
1,358 |
$8K |
| 82105 |
|
563 |
554 |
$8K |
| J7999 |
Compounded drug, noc |
202 |
184 |
$8K |
| 88173 |
|
382 |
321 |
$8K |
| 90682 |
|
334 |
333 |
$8K |
| 86364 |
|
641 |
447 |
$8K |
| 87075 |
|
592 |
548 |
$8K |
| 76937 |
|
250 |
241 |
$7K |
| U0004 |
Cov-19 test non-cdc hgh thru |
120 |
109 |
$7K |
| J2001 |
Lidocaine injection |
1,328 |
1,196 |
$7K |
| 86304 |
|
584 |
515 |
$7K |
| 88142 |
|
1,366 |
1,356 |
$7K |
| 73701 |
|
12 |
12 |
$7K |
| 72128 |
|
12 |
12 |
$7K |
| 76805 |
|
60 |
60 |
$7K |
| J0171 |
Adrenalin epinephrine inject |
131 |
125 |
$7K |
| 84481 |
|
538 |
526 |
$7K |
| 89051 |
|
1,203 |
1,095 |
$7K |
| 92133 |
|
513 |
507 |
$7K |
| 90677 |
|
100 |
100 |
$7K |
| 99354 |
|
60 |
60 |
$7K |
| 86147 |
|
100 |
100 |
$7K |
| 76882 |
|
362 |
328 |
$7K |
| 87486 |
|
86 |
86 |
$6K |
| 87581 |
|
86 |
86 |
$6K |
| J0689 |
Inj cefazolin sodium, baxter |
328 |
275 |
$6K |
| 80069 |
|
1,256 |
1,199 |
$6K |
| 0260 |
|
82 |
81 |
$6K |
| 84165 |
|
728 |
692 |
$6K |
| 77080 |
|
265 |
263 |
$6K |
| 82977 |
|
704 |
629 |
$6K |
| 71020 |
|
285 |
140 |
$6K |
| 82397 |
|
314 |
303 |
$5K |
| 82565 |
|
1,830 |
1,662 |
$5K |
| S0164 |
Injection pantroprazole |
281 |
204 |
$5K |
| P9047 |
Albumin (human), 25%, 50ml |
49 |
15 |
$5K |
| 67028 |
|
122 |
117 |
$5K |
| 97165 |
|
77 |
69 |
$5K |
| 97140 |
|
738 |
457 |
$5K |
| J3371 |
Inj, vancomycin hcl (mylan) |
74 |
66 |
$5K |
| S0020 |
Injection, bupivicaine hydro |
1,148 |
1,061 |
$5K |
| 96402 |
|
494 |
442 |
$5K |
| 86787 |
|
561 |
550 |
$5K |
| 87536 |
|
104 |
98 |
$5K |
| 84153 |
|
424 |
403 |
$5K |
| 73200 |
|
25 |
24 |
$5K |
| J0640 |
Leucovorin calcium injection |
120 |
39 |
$5K |
| 73070 |
|
159 |
139 |
$5K |
| 96900 |
|
501 |
93 |
$5K |
| 86146 |
|
84 |
84 |
$5K |
| 86800 |
|
415 |
380 |
$4K |
| 82043 |
|
1,540 |
1,527 |
$4K |
| 77063 |
|
814 |
810 |
$4K |
| 92550 |
|
165 |
158 |
$4K |
| 94375 |
|
91 |
91 |
$4K |
| 91322 |
|
73 |
73 |
$4K |
| J2919 |
Inj, methylpred sod succ 5mg |
260 |
174 |
$4K |
| 73100 |
|
155 |
122 |
$4K |
| 83883 |
|
309 |
293 |
$4K |
| 73521 |
|
142 |
141 |
$4K |
| 86255 |
|
213 |
206 |
$4K |
| 45385 |
|
40 |
40 |
$4K |
| 86790 |
|
404 |
404 |
$4K |
| J2765 |
Metoclopramide hcl injection |
508 |
483 |
$4K |
| J2272 |
Inj, morphine (fresenius) |
145 |
136 |
$3K |
| 77001 |
|
54 |
54 |
$3K |
| 85384 |
|
343 |
277 |
$3K |
| 70250 |
|
52 |
50 |
$3K |
| J1610 |
Glucagon hydrochloride/1 mg |
15 |
14 |
$3K |
| X4540 |
|
96 |
96 |
$3K |
| 83020 |
|
267 |
238 |
$3K |
| 86592 |
|
580 |
559 |
$3K |
| 87804 |
|
289 |
263 |
$3K |
| 88360 |
|
145 |
102 |
$3K |
| 86431 |
|
423 |
421 |
$3K |
| 92526 |
|
89 |
78 |
$3K |
| J2997 |
Alteplase recombinant |
12 |
12 |
$3K |
| J0571 |
Buprenorphine oral 1mg |
380 |
220 |
$3K |
| 82010 |
|
266 |
250 |
$3K |
| J2560 |
Phenobarbital sodium inj |
27 |
25 |
$3K |
| 92553 |
|
82 |
82 |
$3K |
| Z5916 |
|
56 |
55 |
$3K |
| J1171 |
Inj, hydromorphone, 0.1 mg |
171 |
154 |
$3K |
| 83021 |
|
151 |
119 |
$3K |
| 0730 |
|
232 |
219 |
$3K |
| 84550 |
|
786 |
667 |
$3K |
| J2003 |
Inj, lidocaine hcl, 1 mg |
139 |
129 |
$3K |
| 87517 |
|
193 |
188 |
$3K |
| 84425 |
|
450 |
447 |
$3K |
| 87102 |
|
326 |
309 |
$3K |
| C9113 |
Inj pantoprazole sodium, via |
167 |
133 |
$3K |
| 86665 |
|
63 |
60 |
$3K |
| 85651 |
|
495 |
459 |
$3K |
| 95885 |
|
65 |
55 |
$2K |
| 86301 |
|
157 |
144 |
$2K |
| 82610 |
|
224 |
216 |
$2K |
| 86258 |
|
226 |
126 |
$2K |
| 97162 |
|
25 |
25 |
$2K |
| 51741 |
|
103 |
93 |
$2K |
| 86644 |
|
177 |
168 |
$2K |
| J2175 |
Meperidine hydrochl /100 mg |
172 |
169 |
$2K |
| 83001 |
|
172 |
166 |
$2K |
| 96156 |
|
25 |
24 |
$2K |
| 91200 |
|
152 |
151 |
$2K |
| 86376 |
|
180 |
178 |
$2K |
| 0272 |
|
116 |
93 |
$2K |
| 82525 |
|
332 |
329 |
$2K |
| 72195 |
|
12 |
12 |
$2K |
| 82670 |
|
115 |
111 |
$2K |
| 93880 |
|
12 |
12 |
$2K |
| J0665 |
Inj, bupivacaine, nos, 0.5mg |
879 |
837 |
$2K |
| 92083 |
|
90 |
89 |
$2K |
| 86334 |
|
160 |
151 |
$2K |
| 82747 |
|
148 |
147 |
$2K |
| 00000 |
|
57 |
45 |
$2K |
| 74021 |
|
27 |
26 |
$2K |
| 83525 |
|
209 |
207 |
$2K |
| J9217 |
Leuprolide acetate suspnsion |
12 |
12 |
$2K |
| 84590 |
|
320 |
320 |
$2K |
| J9201 |
In gemcitabine hcl nos 200mg |
82 |
25 |
$2K |
| 84450 |
|
534 |
460 |
$2K |
| 77073 |
|
51 |
49 |
$2K |
| 80178 |
|
115 |
96 |
$1K |
| 76514 |
|
254 |
251 |
$1K |
| 93978 |
|
13 |
13 |
$1K |
| J7042 |
5% dextrose/normal saline |
120 |
114 |
$1K |
| 83993 |
|
114 |
114 |
$1K |
| 85613 |
|
132 |
115 |
$1K |
| 84630 |
|
359 |
355 |
$1K |
| 36561 |
|
12 |
12 |
$1K |
| 74220 |
|
40 |
40 |
$1K |
| 73501 |
|
40 |
37 |
$1K |
| 86762 |
|
183 |
178 |
$1K |
| 77065 |
Tomosynthesis, mammo |
25 |
25 |
$1K |
| 90656 |
|
151 |
151 |
$1K |
| 86200 |
|
176 |
176 |
$1K |
| 84155 |
|
587 |
560 |
$1K |
| J0295 |
Ampicillin sulbactam 1.5 gm |
93 |
68 |
$1K |
| 92507 |
|
85 |
54 |
$1K |
| 90480 |
|
77 |
77 |
$1K |
| Q3014 |
Telehealth facility fee |
136 |
127 |
$1K |
| 85240 |
|
78 |
69 |
$1K |
| 97161 |
|
129 |
119 |
$1K |
| 0324 |
|
255 |
245 |
$1K |
| 83002 |
|
94 |
91 |
$1K |
| 86664 |
|
63 |
60 |
$1K |
| U0002 |
Covid-19 lab test non-cdc |
20 |
15 |
$1K |
| 85246 |
|
39 |
38 |
$1K |
| 87529 |
|
17 |
17 |
$1K |
| Q0111 |
Wet mounts/ w preparations |
419 |
378 |
$996.30 |
| 71010 |
|
63 |
29 |
$990.19 |
| 83051 |
|
96 |
92 |
$986.86 |
| 96376 |
|
16 |
12 |
$975.29 |
| S0077 |
Injection, clindamycin phosp |
69 |
44 |
$972.32 |
| 86663 |
|
63 |
60 |
$953.60 |
| 0420 |
|
605 |
436 |
$945.03 |
| J1611 |
Inj glucagon hcl, fresenius |
12 |
12 |
$922.24 |
| Z5918 |
|
38 |
38 |
$824.60 |
| 87798 |
|
21 |
21 |
$790.33 |
| Z4311 |
|
65 |
65 |
$783.25 |
| 73010 |
|
25 |
25 |
$783.13 |
| 82950 |
|
312 |
308 |
$775.99 |
| 87880 |
|
82 |
79 |
$737.81 |
| 84146 |
|
91 |
91 |
$737.44 |
| 77066 |
Tomosynthesis, mammo |
34 |
34 |
$731.84 |
| 95874 |
|
85 |
81 |
$711.58 |
| 0115U |
|
13 |
13 |
$689.72 |
| Z4302 |
|
26 |
26 |
$626.60 |
| 82310 |
|
184 |
163 |
$621.94 |
| 92025 |
|
112 |
111 |
$600.12 |
| 0424 |
|
73 |
71 |
$596.65 |
| 0302 |
|
69 |
68 |
$586.64 |
| 95983 |
|
12 |
12 |
$579.08 |
| J9263 |
Oxaliplatin |
26 |
12 |
$575.28 |
| 0307 |
|
288 |
278 |
$570.85 |
| 84134 |
|
57 |
55 |
$564.14 |
| 90662 |
|
216 |
212 |
$560.82 |
| 87426 |
|
24 |
15 |
$555.36 |
| 87206 |
|
103 |
93 |
$537.16 |
| 82040 |
|
232 |
213 |
$521.32 |
| J2470 |
Inj pantoprazole sodium 40mg |
60 |
57 |
$502.55 |
| 93297 |
|
208 |
206 |
$478.37 |
| 88312 |
|
45 |
36 |
$458.92 |
| J2550 |
Promethazine hcl injection |
86 |
83 |
$455.72 |
| 64615 |
|
40 |
39 |
$439.28 |
| 74000 |
|
19 |
13 |
$416.08 |
| G0008 |
Admin influenza virus vac |
304 |
304 |
$415.90 |
| 84305 |
|
65 |
62 |
$411.47 |
| 93298 |
|
44 |
44 |
$407.69 |
| J7613 |
Albuterol non-comp unit |
194 |
171 |
$393.58 |
| 85576 |
|
14 |
13 |
$390.78 |
| 85245 |
|
13 |
13 |
$373.49 |
| 80299 |
|
27 |
25 |
$367.07 |
| 88300 |
|
83 |
80 |
$366.72 |
| 86341 |
|
12 |
12 |
$362.77 |
| 97010 |
|
321 |
144 |
$351.41 |
| Q0112 |
Potassium hydroxide preps |
148 |
132 |
$348.85 |
| 87116 |
|
14 |
12 |
$336.04 |
| 86593 |
|
66 |
65 |
$321.31 |
| 96150 |
|
12 |
12 |
$303.05 |
| 86355 |
|
14 |
14 |
$301.44 |
| 87210 |
|
149 |
143 |
$297.39 |
| 83527 |
|
36 |
36 |
$291.74 |
| 82180 |
|
27 |
27 |
$291.04 |
| 94664 |
|
15 |
14 |
$276.21 |
| Z5920 |
|
12 |
12 |
$260.40 |
| 97139 |
|
444 |
143 |
$256.35 |
| 82085 |
|
47 |
42 |
$253.50 |
| J9000 |
Doxorubicin hcl injection |
34 |
12 |
$239.70 |
| 97530 |
|
30 |
15 |
$238.63 |
| 0320 |
|
42 |
42 |
$232.17 |
| 84132 |
|
61 |
57 |
$199.08 |
| 73565 |
|
12 |
12 |
$196.80 |
| 86709 |
|
12 |
12 |
$162.58 |
| 82627 |
|
12 |
12 |
$162.52 |
| J1836 |
Inj, metronidazole, 10 mg |
25 |
24 |
$148.27 |
| H1003 |
Prenatal at risk education |
13 |
12 |
$145.36 |
| 82150 |
|
25 |
25 |
$142.12 |
| 51705 |
|
39 |
36 |
$128.50 |
| 87015 |
|
14 |
12 |
$128.03 |
| 0124A |
|
12 |
12 |
$120.00 |
| 92250 |
|
24 |
24 |
$119.45 |
| G0279 |
Tomosynthesis, mammo |
15 |
15 |
$110.53 |
| 80177 |
|
14 |
12 |
$108.00 |
| 84446 |
|
15 |
15 |
$105.00 |
| 82103 |
|
12 |
12 |
$101.90 |
| 84295 |
|
29 |
29 |
$99.01 |
| 90744 |
|
17 |
13 |
$98.73 |
| 83721 |
|
12 |
12 |
$94.91 |
| G1003 |
Cdsm medicalis |
538 |
468 |
$94.49 |
| 87324 |
|
14 |
14 |
$90.50 |
| 82435 |
|
25 |
25 |
$90.06 |
| 82272 |
|
16 |
16 |
$89.83 |
| 83930 |
|
14 |
13 |
$83.18 |
| T1999 |
Noc retail items andsupplies |
22 |
13 |
$63.13 |
| J9260 |
Inj methotrexate sodium 50mg |
73 |
52 |
$56.33 |
| 0402 |
|
24 |
24 |
$52.24 |
| 84207 |
|
14 |
14 |
$35.00 |
| 90732 |
|
13 |
13 |
$34.50 |
| 99459 |
|
13 |
13 |
$30.42 |
| 88311 |
|
13 |
12 |
$29.71 |
| 0352 |
|
91 |
91 |
$0.00 |
| 0258 |
|
152 |
147 |
$0.00 |
| 51798 |
|
28 |
28 |
$0.00 |
| 97810 |
|
64 |
27 |
$0.00 |