| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 77386 |
|
915 |
83 |
$300K |
| 78815 |
|
238 |
228 |
$222K |
| 71260 |
|
1,655 |
1,607 |
$146K |
| 77067 |
|
1,286 |
1,272 |
$108K |
| 74177 |
|
343 |
339 |
$82K |
| 97110 |
|
426 |
182 |
$38K |
| 11102 |
|
174 |
169 |
$38K |
| 76642 |
|
694 |
629 |
$37K |
| 77412 |
|
708 |
89 |
$33K |
| 97140 |
|
222 |
90 |
$33K |
| U0003 |
Cov-19 amp prb hgh thruput |
482 |
439 |
$32K |
| 74183 |
|
68 |
67 |
$27K |
| A9552 |
F18 fdg |
250 |
240 |
$26K |
| 99211 |
|
586 |
535 |
$25K |
| 77336 |
|
569 |
285 |
$25K |
| 77334 |
|
262 |
187 |
$24K |
| 71250 |
|
358 |
353 |
$24K |
| 96413 |
|
344 |
221 |
$22K |
| 77066 |
Tomosynthesis, mammo |
232 |
223 |
$22K |
| 99213 |
|
406 |
394 |
$20K |
| 77065 |
Tomosynthesis, mammo |
294 |
269 |
$20K |
| 80053 |
|
2,904 |
2,230 |
$19K |
| 76376 |
|
936 |
913 |
$16K |
| 72197 |
|
40 |
38 |
$15K |
| 99212 |
|
220 |
206 |
$13K |
| 70553 |
|
55 |
55 |
$12K |
| 88305 |
|
1,172 |
1,053 |
$12K |
| 17311 |
|
40 |
37 |
$10K |
| 85025 |
|
3,111 |
2,337 |
$10K |
| 43239 |
|
30 |
28 |
$10K |
| 88341 |
|
97 |
89 |
$7K |
| 77063 |
|
328 |
327 |
$6K |
| 77300 |
|
61 |
55 |
$4K |
| 71046 |
|
268 |
260 |
$4K |
| 88342 |
|
166 |
156 |
$4K |
| 88313 |
|
107 |
100 |
$4K |
| 78306 |
|
60 |
57 |
$4K |
| 86304 |
|
107 |
78 |
$3K |
| 77062 |
|
94 |
89 |
$3K |
| 96367 |
|
224 |
143 |
$3K |
| U0001 |
2019-ncov diagnostic p |
125 |
113 |
$3K |
| 88112 |
|
147 |
142 |
$3K |
| 83735 |
|
448 |
346 |
$2K |
| 93005 |
|
325 |
314 |
$2K |
| 74178 |
|
12 |
12 |
$2K |
| 77280 |
|
62 |
44 |
$2K |
| 70491 |
|
12 |
12 |
$2K |
| 99214 |
|
32 |
32 |
$2K |
| 99204 |
|
14 |
14 |
$1K |
| G0279 |
Tomosynthesis, mammo |
70 |
69 |
$1K |
| 99202 |
|
24 |
24 |
$1K |
| 76536 |
|
27 |
27 |
$1K |
| 36591 |
|
110 |
70 |
$1K |
| 88360 |
|
26 |
24 |
$1K |
| A9575 |
Inj gadoterate meglumi 0.1ml |
510 |
490 |
$1K |
| 88173 |
|
25 |
24 |
$969.96 |
| 82565 |
|
235 |
230 |
$899.98 |
| G0463 |
Hospital outpt clinic visit |
153 |
110 |
$890.69 |
| 84100 |
|
220 |
149 |
$866.99 |
| 88142 |
|
52 |
52 |
$683.64 |
| 83615 |
|
108 |
90 |
$607.52 |
| 77061 |
|
25 |
25 |
$540.24 |
| 52000 |
|
12 |
12 |
$450.23 |
| 80048 |
|
159 |
128 |
$425.44 |
| 99153 |
Mod sedat endo service >5yrs |
68 |
62 |
$394.58 |
| 94729 |
|
14 |
14 |
$390.15 |
| 99152 |
|
68 |
62 |
$373.14 |
| 94726 |
|
13 |
13 |
$357.43 |
| J1100 |
Dexamethasone sodium phos |
994 |
805 |
$231.56 |
| 88312 |
|
26 |
25 |
$212.20 |
| 88307 |
|
25 |
25 |
$204.74 |
| 78999 |
|
15 |
12 |
$184.13 |
| 85610 |
|
87 |
83 |
$178.81 |
| 96402 |
|
15 |
12 |
$170.10 |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
2,250 |
2,187 |
$169.70 |
| J3010 |
Fentanyl citrate injection |
1,351 |
1,182 |
$125.13 |
| 94010 |
|
12 |
12 |
$122.24 |
| J2704 |
Inj, propofol, 10 mg |
1,256 |
1,180 |
$85.35 |
| J2405 |
Ondansetron hcl injection |
868 |
732 |
$72.47 |
| 82948 |
|
45 |
42 |
$72.31 |
| 87086 |
|
14 |
13 |
$58.63 |
| J0690 |
Cefazolin sodium injection |
317 |
297 |
$48.41 |
| J2250 |
Inj midazolam hydrochloride |
1,071 |
944 |
$29.76 |
| 86850 |
|
17 |
14 |
$12.33 |
| 86901 |
|
17 |
14 |
$6.08 |
| 86900 |
|
17 |
14 |
$6.01 |
| J7120 |
Ringers lactate infusion |
16 |
12 |
$0.02 |
| J1170 |
Hydromorphone injection |
62 |
51 |
$0.00 |
| A9270 |
Non-covered item or service |
28 |
12 |
$0.00 |
| 82378 |
|
14 |
12 |
$0.00 |
| J2001 |
Lidocaine injection |
136 |
135 |
$0.00 |
| J3490 |
Drugs unclassified injection |
278 |
122 |
$0.00 |
| 84443 |
|
27 |
26 |
$0.00 |
| J1596 |
Inj, glycopyrrolate, 0.1 mg |
13 |
13 |
$0.00 |