| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90999 |
|
67,690 |
5,516 |
$8.55M |
| J0882 |
Darbepoetin alfa, esrd use |
11,749 |
2,857 |
$1.10M |
| J0606 |
Inj, etelcalcetide, 0.1 mg |
3,672 |
234 |
$354K |
| Q4081 |
Epoetin alfa, 100 units esrd |
4,157 |
428 |
$110K |
| J1756 |
Iron sucrose injection |
4,144 |
2,084 |
$98K |
| 90677 |
|
32 |
32 |
$4K |
| 90747 |
|
40 |
40 |
$3K |
| 90688 |
|
126 |
126 |
$2K |
| 90694 |
|
62 |
62 |
$1K |
| 90661 |
|
31 |
31 |
$938.86 |
| 83970 |
|
558 |
547 |
$583.54 |
| 90732 |
|
14 |
14 |
$535.00 |
| 85025 |
|
1,473 |
1,380 |
$533.81 |
| 84520 |
|
3,224 |
1,486 |
$418.07 |
| 90756 |
|
18 |
18 |
$413.64 |
| 90653 |
|
12 |
12 |
$327.28 |
| 85045 |
|
1,519 |
1,443 |
$278.46 |
| 84100 |
|
1,565 |
1,459 |
$273.83 |
| 82040 |
|
1,553 |
1,430 |
$249.12 |
| 80051 |
|
524 |
512 |
$248.58 |
| 87340 |
|
759 |
731 |
$208.36 |
| J1644 |
Inj heparin sodium per 1000u |
685 |
60 |
$159.64 |
| 82947 |
|
788 |
769 |
$142.27 |
| 82435 |
|
850 |
818 |
$116.92 |
| 85018 |
|
1,392 |
570 |
$75.95 |
| 84466 |
|
513 |
489 |
$68.26 |
| 82728 |
|
474 |
462 |
$62.75 |
| 83540 |
|
512 |
488 |
$35.48 |
| 83036 |
|
192 |
190 |
$26.91 |
| G0008 |
Admin influenza virus vac |
143 |
143 |
$25.29 |
| 84443 |
|
139 |
139 |
$15.50 |
| 84450 |
|
1,307 |
1,290 |
$10.73 |
| 86706 |
|
128 |
126 |
$9.99 |
| 83718 |
|
127 |
127 |
$7.09 |
| 84478 |
|
127 |
127 |
$5.27 |
| 84460 |
|
152 |
152 |
$4.81 |
| 82565 |
|
1,438 |
1,403 |
$4.31 |
| 84075 |
|
1,454 |
1,422 |
$4.13 |
| 82310 |
|
1,588 |
1,402 |
$4.10 |
| 82465 |
|
128 |
128 |
$4.08 |
| 84155 |
|
1,388 |
1,365 |
$2.96 |
| A4913 |
Misc dialysis supplies noc |
3,005 |
817 |
$2.21 |
| J8499 |
Oral prescrip drug non chemo |
5,571 |
405 |
$0.46 |
| 84295 |
|
805 |
789 |
$0.00 |
| 82374 |
|
804 |
788 |
$0.00 |
| 80061 |
|
79 |
78 |
$0.00 |
| 90662 |
|
34 |
34 |
$0.00 |
| 84550 |
|
26 |
26 |
$0.00 |
| G0009 |
Admin pneumococcal vaccine |
16 |
16 |
$0.00 |
| 84132 |
|
996 |
807 |
$0.00 |
| A4657 |
Syringe w/wo needle |
4,908 |
648 |
$0.00 |