| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 77067 |
|
605 |
511 |
$165K |
| 99284 |
|
2,014 |
1,568 |
$145K |
| J3490 |
Drugs unclassified injection |
1,725 |
900 |
$56K |
| 0450 |
|
630 |
529 |
$53K |
| 96374 |
|
594 |
494 |
$51K |
| 70450 |
|
186 |
168 |
$49K |
| 74177 |
|
107 |
104 |
$40K |
| 80053 |
|
1,532 |
1,296 |
$33K |
| 93005 |
|
860 |
719 |
$33K |
| 76700 |
|
279 |
240 |
$32K |
| 77066 |
Tomosynthesis, mammo |
71 |
64 |
$25K |
| 96375 |
|
362 |
304 |
$21K |
| 99231 |
|
329 |
247 |
$18K |
| 77065 |
Tomosynthesis, mammo |
73 |
60 |
$18K |
| 80307 |
|
174 |
156 |
$17K |
| 85025 |
|
1,622 |
1,365 |
$16K |
| 76999 |
|
51 |
44 |
$15K |
| 87502 |
|
105 |
96 |
$12K |
| 96361 |
|
315 |
252 |
$12K |
| 96365 |
|
107 |
102 |
$12K |
| T1999 |
Noc retail items andsupplies |
448 |
237 |
$11K |
| 71046 |
|
305 |
293 |
$11K |
| 76856 |
|
119 |
105 |
$11K |
| 76830 |
|
107 |
94 |
$10K |
| 76642 |
|
118 |
101 |
$9K |
| 71275 |
|
24 |
20 |
$9K |
| 74176 |
|
50 |
45 |
$8K |
| 71045 |
|
441 |
406 |
$8K |
| 96360 |
|
98 |
85 |
$8K |
| 93971 |
|
36 |
34 |
$8K |
| J2405 |
Ondansetron hcl injection |
320 |
258 |
$8K |
| J0131 |
Inj, acetaminophen (nos) |
69 |
37 |
$8K |
| 84484 |
|
511 |
402 |
$7K |
| 94640 |
|
162 |
130 |
$6K |
| 71250 |
|
23 |
17 |
$6K |
| J0561 |
Penicillin g benzathine inj |
17 |
13 |
$6K |
| 86803 |
|
280 |
255 |
$6K |
| 87491 |
|
101 |
93 |
$5K |
| 87591 |
|
101 |
93 |
$5K |
| 72125 |
|
16 |
13 |
$5K |
| 86703 |
|
262 |
240 |
$5K |
| 76536 |
|
57 |
49 |
$5K |
| G0297 |
Ldct for lung ca screen |
15 |
15 |
$5K |
| J7030 |
Normal saline solution infus |
397 |
310 |
$4K |
| 96372 |
|
134 |
99 |
$4K |
| 83690 |
|
414 |
360 |
$4K |
| 83880 |
|
93 |
81 |
$4K |
| J1885 |
Ketorolac tromethamine inj |
323 |
272 |
$4K |
| 83605 |
|
246 |
140 |
$4K |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
266 |
165 |
$4K |
| 71020 |
|
92 |
77 |
$4K |
| 76801 |
|
39 |
36 |
$3K |
| J1815 |
Insulin injection |
24 |
17 |
$3K |
| 99283 |
|
43 |
41 |
$3K |
| 0510 |
|
45 |
42 |
$3K |
| 87040 |
|
188 |
99 |
$2K |
| 94729 |
|
32 |
31 |
$2K |
| 87086 |
|
208 |
191 |
$2K |
| 71010 |
|
95 |
88 |
$2K |
| 90715 |
|
42 |
35 |
$2K |
| 81001 |
|
414 |
373 |
$2K |
| 80047 |
|
83 |
74 |
$2K |
| 72100 |
|
47 |
41 |
$2K |
| 82947 |
|
150 |
124 |
$2K |
| 76770 |
|
19 |
16 |
$2K |
| J0696 |
Ceftriaxone sodium injection |
109 |
101 |
$2K |
| 81025 |
|
236 |
206 |
$2K |
| 76705 |
|
20 |
16 |
$2K |
| 99281 |
|
54 |
45 |
$2K |
| J2270 |
Morphine sulfate injection |
178 |
141 |
$2K |
| 73030 |
|
39 |
34 |
$2K |
| 72040 |
|
29 |
25 |
$2K |
| 84703 |
|
192 |
156 |
$1K |
| 84702 |
|
79 |
73 |
$1K |
| 76817 |
|
18 |
17 |
$1K |
| J2001 |
Lidocaine injection |
56 |
43 |
$1K |
| 73562 |
|
40 |
32 |
$1K |
| 83735 |
|
147 |
127 |
$1K |
| G0279 |
Tomosynthesis, mammo |
16 |
12 |
$1K |
| 73610 |
|
32 |
30 |
$1K |
| 73630 |
|
32 |
29 |
$1K |
| 85610 |
|
222 |
196 |
$1K |
| 87400 |
|
147 |
129 |
$1K |
| 85730 |
|
131 |
118 |
$1K |
| J1170 |
Hydromorphone injection |
93 |
64 |
$1K |
| 94727 |
|
18 |
17 |
$1K |
| 77080 |
|
14 |
13 |
$998.30 |
| 90686 |
|
24 |
18 |
$912.96 |
| S0164 |
Injection pantroprazole |
45 |
38 |
$865.30 |
| 81003 |
|
215 |
187 |
$792.42 |
| J2765 |
Metoclopramide hcl injection |
92 |
74 |
$737.64 |
| 96366 |
|
13 |
12 |
$690.21 |
| 80048 |
|
43 |
37 |
$676.03 |
| 73130 |
|
16 |
15 |
$633.08 |
| 85379 |
|
37 |
35 |
$617.51 |
| J2930 |
Methylprednisolone injection |
38 |
29 |
$571.53 |
| 87077 |
|
61 |
51 |
$566.48 |
| J1200 |
Diphenhydramine hcl injectio |
65 |
52 |
$550.34 |
| 87186 |
|
55 |
49 |
$545.96 |
| J2060 |
Lorazepam injection |
77 |
63 |
$542.80 |
| 94644 |
|
16 |
14 |
$508.89 |
| J7050 |
Normal saline solution infus |
21 |
15 |
$507.03 |
| 87081 |
|
46 |
41 |
$472.23 |
| J7620 |
Albuterol ipratrop non-comp |
259 |
187 |
$420.53 |
| 90471 |
|
56 |
48 |
$395.91 |
| 87210 |
|
58 |
54 |
$350.22 |
| 86850 |
|
29 |
28 |
$258.42 |
| 85014 |
|
80 |
72 |
$237.15 |
| 86901 |
|
46 |
45 |
$225.03 |
| J1940 |
Furosemide injection |
16 |
15 |
$224.26 |
| J2250 |
Inj midazolam hydrochloride |
18 |
15 |
$202.29 |
| 86900 |
|
48 |
43 |
$194.60 |
| J7040 |
Normal saline solution infus |
19 |
18 |
$156.90 |
| 99070 |
|
18 |
13 |
$62.12 |
| 0250 |
|
20 |
18 |
$10.74 |
| G0463 |
Hospital outpt clinic visit |
35 |
34 |
$0.00 |
| 0250R |
|
15 |
14 |
$0.00 |