| Code | Description | Claims | Beneficiaries | Total Paid |
| J3490 |
Drugs unclassified injection |
71,856 |
30,515 |
$13.34M |
| 0450 |
|
59,037 |
53,326 |
$2.30M |
| 0121 |
|
245 |
235 |
$2.01M |
| 82803 |
|
1,141 |
1,110 |
$1.38M |
| 0202U |
|
3,668 |
3,626 |
$1.07M |
| 74177 |
|
3,824 |
3,753 |
$710K |
| 96374 |
|
10,650 |
9,875 |
$600K |
| 0272 |
|
5,549 |
5,365 |
$565K |
| G0480 |
Drug test def 1-7 classes |
2,821 |
2,665 |
$426K |
| Q0162 |
Ondansetron oral |
5,473 |
5,282 |
$376K |
| 0123 |
|
57 |
51 |
$359K |
| 78815 |
|
268 |
267 |
$348K |
| 0241U |
|
2,710 |
2,625 |
$341K |
| 93005 |
|
15,855 |
14,812 |
$310K |
| 70450 |
|
3,849 |
3,771 |
$303K |
| 80053 |
|
25,822 |
23,807 |
$273K |
| C9803 |
Hopd covid-19 spec collect |
6,181 |
6,002 |
$264K |
| J7030 |
Normal saline solution infus |
11,413 |
9,565 |
$221K |
| 87635 |
|
4,485 |
4,359 |
$209K |
| 85025 |
|
30,462 |
27,056 |
$209K |
| 96361 |
|
8,693 |
7,685 |
$207K |
| 96376 |
|
2,697 |
1,768 |
$199K |
| 96375 |
|
7,008 |
6,103 |
$196K |
| 0250 |
|
2,008 |
1,343 |
$192K |
| 96360 |
|
3,221 |
3,020 |
$188K |
| 74176 |
|
1,576 |
1,555 |
$164K |
| 99199 |
|
3,186 |
2,834 |
$162K |
| 72125 |
|
1,417 |
1,406 |
$151K |
| 93976 |
|
871 |
855 |
$151K |
| 76705 |
|
3,274 |
3,206 |
$148K |
| 71045 |
|
10,110 |
9,772 |
$148K |
| 96372 |
|
6,632 |
5,010 |
$147K |
| 0171 |
Inj, epinephrine (belcher) |
108 |
105 |
$145K |
| 71046 |
|
6,662 |
6,562 |
$140K |
| 80307 |
|
1,543 |
1,496 |
$134K |
| 71260 |
|
1,080 |
1,077 |
$130K |
| 76856 |
|
2,428 |
2,395 |
$125K |
| 99283 |
|
1,662 |
1,447 |
$125K |
| 77067 |
|
1,397 |
1,397 |
$124K |
| 97110 |
|
9,095 |
3,939 |
$121K |
| 87502 |
|
1,549 |
1,533 |
$113K |
| 70498 |
|
647 |
644 |
$109K |
| 76830 |
|
1,906 |
1,886 |
$100K |
| 97140 |
|
4,331 |
2,125 |
$96K |
| 99281 |
|
1,202 |
1,092 |
$94K |
| 99284 |
|
2,171 |
1,977 |
$91K |
| U0003 |
Cov-19 amp prb hgh thruput |
1,233 |
1,164 |
$91K |
| 97530 |
|
4,475 |
2,730 |
$90K |
| 93306 |
|
363 |
363 |
$90K |
| 84484 |
|
10,345 |
8,840 |
$89K |
| 93971 |
|
1,123 |
1,103 |
$87K |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
6,482 |
5,970 |
$84K |
| 96365 |
|
1,111 |
995 |
$81K |
| 71275 |
|
419 |
416 |
$77K |
| 87651 |
|
2,153 |
2,131 |
$74K |
| 70496 |
|
332 |
331 |
$67K |
| 80048 |
|
5,740 |
5,075 |
$67K |
| 99070 |
|
1,914 |
909 |
$64K |
| A9552 |
F18 fdg |
277 |
277 |
$64K |
| 76801 |
|
977 |
855 |
$63K |
| 83690 |
|
9,636 |
9,052 |
$60K |
| 76770 |
|
1,026 |
1,015 |
$59K |
| 76700 |
|
941 |
936 |
$57K |
| 0720 |
|
2,228 |
1,784 |
$53K |
| 59025 |
|
2,012 |
1,596 |
$52K |
| 0122 |
|
15 |
12 |
$50K |
| 84703 |
|
7,964 |
7,640 |
$49K |
| 80320 |
|
423 |
399 |
$48K |
| 81001 |
|
16,095 |
15,272 |
$48K |
| 76642 |
|
952 |
836 |
$43K |
| 87086 |
|
6,180 |
5,959 |
$42K |
| 99233 |
Prolong inpt eval add15 m |
976 |
396 |
$41K |
| 97161 |
|
831 |
829 |
$39K |
| 77386 |
|
108 |
12 |
$38K |
| 76817 |
|
610 |
545 |
$38K |
| 74018 |
|
2,058 |
2,016 |
$35K |
| J2405 |
Ondansetron hcl injection |
6,678 |
5,811 |
$35K |
| 77066 |
Tomosynthesis, mammo |
384 |
384 |
$34K |
| 94664 |
|
2,351 |
2,270 |
$33K |
| 83880 |
|
1,309 |
1,269 |
$33K |
| 97139 |
|
2,016 |
550 |
$33K |
| 84443 |
|
2,176 |
2,117 |
$32K |
| Z7502 |
|
1,369 |
1,277 |
$31K |
| 73564 |
|
1,393 |
1,383 |
$31K |
| 77063 |
|
1,353 |
1,353 |
$30K |
| J2270 |
Morphine sulfate injection |
3,525 |
2,993 |
$30K |
| 87040 |
|
3,402 |
2,027 |
$29K |
| 84702 |
|
2,307 |
2,114 |
$29K |
| J1885 |
Ketorolac tromethamine inj |
5,042 |
4,718 |
$29K |
| 0510 |
|
1,214 |
1,126 |
$28K |
| 99291 |
|
252 |
68 |
$28K |
| 73630 |
|
1,309 |
1,300 |
$26K |
| T1999 |
Noc retail items andsupplies |
1,917 |
995 |
$25K |
| 70553 |
|
126 |
126 |
$24K |
| 83605 |
|
3,086 |
2,763 |
$23K |
| J1170 |
Hydromorphone injection |
2,373 |
1,750 |
$21K |
| 80306 |
|
393 |
372 |
$20K |
| 73030 |
|
976 |
970 |
$20K |
| 77301 |
|
26 |
26 |
$19K |
| 76536 |
|
382 |
381 |
$19K |
| 73610 |
|
923 |
920 |
$18K |
| 77065 |
Tomosynthesis, mammo |
257 |
257 |
$18K |
| 82553 |
|
349 |
329 |
$16K |
| 87077 |
|
2,367 |
1,932 |
$15K |
| 71250 |
|
160 |
160 |
$15K |
| 87491 |
|
689 |
674 |
$15K |
| J0696 |
Ceftriaxone sodium injection |
1,996 |
1,736 |
$15K |
| 72100 |
|
643 |
641 |
$14K |
| 0002A |
|
359 |
359 |
$14K |
| 93010 |
|
1,041 |
886 |
$13K |
| 87186 |
|
1,886 |
1,633 |
$13K |
| 0001A |
|
323 |
323 |
$13K |
| 99232 |
|
339 |
185 |
$12K |
| 87591 |
|
687 |
673 |
$11K |
| 85379 |
|
1,223 |
1,200 |
$11K |
| 77049 |
|
32 |
32 |
$10K |
| 77336 |
|
269 |
137 |
$10K |
| 77300 |
|
106 |
102 |
$10K |
| J7620 |
Albuterol ipratrop non-comp |
1,626 |
1,469 |
$10K |
| 77338 |
|
55 |
53 |
$10K |
| 85730 |
|
1,982 |
1,917 |
$10K |
| J7050 |
Normal saline solution infus |
1,830 |
1,608 |
$9K |
| 85610 |
|
2,885 |
2,759 |
$9K |
| 83735 |
|
1,558 |
1,351 |
$9K |
| A9585 |
Gadobutrol injection |
360 |
346 |
$9K |
| 73130 |
|
356 |
351 |
$8K |
| 72110 |
|
206 |
206 |
$8K |
| 86901 |
|
3,231 |
3,151 |
$7K |
| 97162 |
|
156 |
156 |
$7K |
| 87661 |
|
230 |
225 |
$7K |
| J1200 |
Diphenhydramine hcl injectio |
1,302 |
1,151 |
$7K |
| 86900 |
|
2,921 |
2,863 |
$7K |
| 86850 |
|
2,448 |
2,389 |
$7K |
| 97014 |
|
759 |
327 |
$7K |
| 80047 |
|
1,099 |
1,080 |
$7K |
| 85027 |
|
1,729 |
1,633 |
$7K |
| J2704 |
Inj, propofol, 10 mg |
345 |
282 |
$6K |
| 94729 |
|
123 |
123 |
$6K |
| 0360 |
|
117 |
63 |
$6K |
| 87633 |
|
16 |
16 |
$6K |
| J0780 |
Prochlorperazine injection |
426 |
402 |
$5K |
| G0299 |
Hhs/hospice of rn ea 15 min |
33 |
26 |
$5K |
| 70486 |
|
52 |
52 |
$5K |
| J2060 |
Lorazepam injection |
990 |
863 |
$5K |
| 77334 |
|
49 |
43 |
$5K |
| J3010 |
Fentanyl citrate injection |
988 |
879 |
$4K |
| 73110 |
|
207 |
205 |
$4K |
| 87070 |
|
450 |
443 |
$4K |
| 87507 |
|
12 |
12 |
$4K |
| 73502 |
|
135 |
134 |
$4K |
| J7611 |
Albuterol non-comp con |
345 |
332 |
$4K |
| J7120 |
Ringers lactate infusion |
523 |
433 |
$4K |
| 82550 |
|
712 |
636 |
$4K |
| 86140 |
|
797 |
752 |
$4K |
| J1100 |
Dexamethasone sodium phos |
598 |
584 |
$3K |
| 0420 |
|
298 |
292 |
$3K |
| 0636 |
|
304 |
181 |
$3K |
| 76377 |
|
296 |
285 |
$3K |
| 77062 |
|
338 |
338 |
$3K |
| Z7610 |
|
423 |
360 |
$3K |
| 84145 |
|
153 |
138 |
$3K |
| J8540 |
Oral dexamethasone |
508 |
270 |
$3K |
| 90715 |
|
99 |
99 |
$3K |
| 72040 |
|
126 |
126 |
$2K |
| J7512 |
Prednisone ir or dr oral 1mg |
794 |
726 |
$2K |
| 97112 |
|
170 |
94 |
$2K |
| 82150 |
|
952 |
940 |
$2K |
| 73140 |
|
144 |
142 |
$2K |
| 0710 |
|
237 |
199 |
$2K |
| 0762 |
|
492 |
245 |
$2K |
| 83036 |
|
239 |
237 |
$2K |
| 97165 |
|
29 |
29 |
$2K |
| 97166 |
|
25 |
25 |
$2K |
| 76870 |
|
40 |
40 |
$2K |
| J1815 |
Insulin injection |
106 |
49 |
$2K |
| J2765 |
Metoclopramide hcl injection |
251 |
231 |
$2K |
| 94726 |
|
39 |
39 |
$1K |
| 85652 |
|
655 |
620 |
$1K |
| J1756 |
Iron sucrose injection |
22 |
12 |
$1K |
| J1650 |
Inj enoxaparin sodium |
149 |
66 |
$1K |
| J7040 |
Normal saline solution infus |
229 |
225 |
$1K |
| 73080 |
|
57 |
56 |
$1K |
| 73590 |
|
86 |
83 |
$1K |
| 77061 |
|
135 |
135 |
$1K |
| J1171 |
Inj, hydromorphone, 0.1 mg |
49 |
35 |
$971.21 |
| 84439 |
|
126 |
121 |
$949.82 |
| 85049 |
|
319 |
297 |
$934.37 |
| 85014 |
|
366 |
334 |
$925.90 |
| 36430 |
|
3,222 |
1,399 |
$907.36 |
| Q0163 |
Diphenhydramine hcl 50mg |
223 |
199 |
$850.42 |
| 0370 |
|
32 |
32 |
$826.88 |
| G0108 |
Diab manage trn per indiv |
13 |
12 |
$823.32 |
| J2001 |
Lidocaine injection |
122 |
119 |
$823.00 |
| 94060 |
|
26 |
26 |
$749.19 |
| 77077 |
|
25 |
25 |
$690.87 |
| 87420 |
|
166 |
165 |
$599.27 |
| 85018 |
|
330 |
303 |
$596.05 |
| 72082 |
|
14 |
14 |
$591.22 |
| 0270 |
|
278 |
143 |
$548.76 |
| 88305 |
|
12 |
12 |
$537.31 |
| 87581 |
|
16 |
16 |
$511.97 |
| 87486 |
|
16 |
16 |
$511.97 |
| 87798 |
|
17 |
17 |
$488.00 |
| 84450 |
|
106 |
105 |
$463.59 |
| 85048 |
|
247 |
246 |
$447.43 |
| 84075 |
|
106 |
105 |
$434.40 |
| 82247 |
|
106 |
105 |
$430.19 |
| 82040 |
|
107 |
106 |
$427.05 |
| 97039 |
|
26 |
12 |
$415.92 |
| 72050 |
|
13 |
13 |
$413.49 |
| 0300 |
|
392 |
375 |
$408.08 |
| 82565 |
|
225 |
219 |
$387.39 |
| J3480 |
Inj potassium chloride |
36 |
28 |
$378.85 |
| 0301 |
|
464 |
440 |
$372.65 |
| 90471 |
|
62 |
62 |
$364.53 |
| 80051 |
|
178 |
178 |
$349.97 |
| 72070 |
|
13 |
13 |
$327.34 |
| J2250 |
Inj midazolam hydrochloride |
65 |
62 |
$314.31 |
| 96366 |
|
14 |
13 |
$313.12 |
| 84155 |
|
106 |
105 |
$312.33 |
| 73560 |
|
31 |
31 |
$306.79 |
| 73620 |
|
13 |
13 |
$236.34 |
| J0131 |
Inj, acetaminophen (nos) |
14 |
13 |
$231.20 |
| 81003 |
|
112 |
111 |
$222.63 |
| J0690 |
Cefazolin sodium injection |
33 |
26 |
$199.96 |
| 82947 |
|
182 |
182 |
$196.96 |
| S0265 |
Genetic counsel 15 mins |
13 |
13 |
$195.00 |
| 84520 |
|
192 |
191 |
$192.40 |
| 72170 |
|
14 |
14 |
$169.44 |
| J2930 |
Methylprednisolone injection |
14 |
12 |
$164.24 |
| 87210 |
|
41 |
40 |
$153.83 |
| 73070 |
|
12 |
12 |
$117.60 |
| 82570 |
|
24 |
24 |
$110.86 |
| 84550 |
|
29 |
27 |
$105.07 |
| J1644 |
Inj heparin sodium per 1000u |
16 |
14 |
$104.70 |
| 82330 |
|
12 |
12 |
$103.68 |
| 97035 |
|
18 |
12 |
$102.01 |
| J7613 |
Albuterol non-comp unit |
78 |
73 |
$92.83 |
| 82248 |
|
16 |
12 |
$70.28 |
| 83615 |
|
14 |
14 |
$64.44 |
| 84156 |
|
13 |
12 |
$42.38 |
| 87205 |
|
14 |
13 |
$38.35 |
| 84295 |
|
12 |
12 |
$30.00 |
| 84132 |
|
12 |
12 |
$29.72 |
| G1004 |
Cdsm ndsc |
150 |
120 |
$0.02 |
| 0258 |
|
98 |
94 |
$0.00 |
| 0410 |
|
99 |
96 |
$0.00 |
| 0306 |
|
276 |
267 |
$0.00 |
| 0307 |
|
158 |
154 |
$0.00 |
| 0305 |
|
404 |
387 |
$0.00 |
| 0324 |
|
157 |
151 |
$0.00 |
| 0271 |
|
104 |
103 |
$0.00 |
| 0310 |
|
25 |
25 |
$0.00 |
| 80329 |
|
28 |
13 |
$0.00 |
| 0730 |
|
166 |
162 |
$0.00 |
| 0470 |
|
93 |
90 |
$0.00 |
| 0302 |
|
135 |
131 |
$0.00 |
| 0402 |
|
77 |
75 |
$0.00 |
| 0320 |
|
84 |
81 |
$0.00 |
| 0430 |
|
12 |
12 |
$0.00 |