| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99284 |
|
7,909 |
7,335 |
$4.28M |
| 99282 |
|
15,659 |
14,994 |
$4.15M |
| 99283 |
|
8,848 |
8,483 |
$4.02M |
| 0450 |
|
57,073 |
51,064 |
$2.24M |
| 74177 |
|
6,418 |
6,243 |
$1.92M |
| 99285 |
|
2,042 |
1,902 |
$1.45M |
| 99281 |
|
9,033 |
8,663 |
$1.04M |
| 87637 |
|
11,443 |
11,082 |
$886K |
| 70450 |
|
5,740 |
5,592 |
$660K |
| 71046 |
|
11,068 |
10,765 |
$584K |
| 74176 |
|
2,432 |
2,389 |
$393K |
| 76705 |
|
3,092 |
3,036 |
$272K |
| 71045 |
|
6,519 |
6,267 |
$266K |
| 71260 |
|
1,294 |
1,266 |
$244K |
| 87635 |
|
8,206 |
7,921 |
$235K |
| 76830 |
|
2,224 |
2,168 |
$226K |
| 76856 |
|
2,179 |
2,134 |
$212K |
| 85025 |
|
43,985 |
37,746 |
$197K |
| 93005 |
|
13,872 |
12,829 |
$187K |
| 96374 |
|
6,388 |
5,809 |
$182K |
| J0131 |
Inj, acetaminophen (nos) |
3,468 |
3,291 |
$178K |
| 73630 |
|
2,602 |
2,373 |
$157K |
| 71275 |
|
635 |
618 |
$157K |
| 36415 |
|
28,841 |
22,945 |
$138K |
| 76815 |
|
1,345 |
1,279 |
$128K |
| 73610 |
|
2,171 |
2,034 |
$122K |
| 83880 |
|
5,970 |
5,623 |
$121K |
| U0003 |
Cov-19 amp prb hgh thruput |
2,251 |
2,230 |
$119K |
| 96375 |
|
5,480 |
4,997 |
$119K |
| 86900 |
|
2,837 |
2,678 |
$117K |
| 80051 |
|
30,049 |
27,115 |
$114K |
| 73130 |
|
1,858 |
1,669 |
$111K |
| 0270 |
|
5,421 |
3,829 |
$108K |
| 73560 |
|
2,060 |
1,851 |
$100K |
| 73110 |
|
1,535 |
1,398 |
$100K |
| 72125 |
|
674 |
668 |
$98K |
| 73030 |
|
1,649 |
1,534 |
$96K |
| 82565 |
|
34,782 |
30,395 |
$94K |
| 70551 |
|
326 |
322 |
$93K |
| 59025 |
|
675 |
563 |
$93K |
| 87631 |
|
1,896 |
1,854 |
$89K |
| 80307 |
|
2,282 |
2,102 |
$85K |
| 84702 |
|
6,321 |
4,841 |
$82K |
| G0378 |
Hospital observation per hr |
562 |
357 |
$81K |
| 96372 |
|
6,454 |
6,131 |
$81K |
| 76817 |
|
849 |
782 |
$76K |
| 82247 |
|
24,654 |
20,567 |
$74K |
| 74018 |
|
1,090 |
1,059 |
$72K |
| 84460 |
|
23,112 |
20,092 |
$69K |
| 96361 |
|
4,478 |
4,186 |
$69K |
| 93976 |
|
302 |
298 |
$69K |
| 87651 |
|
3,426 |
3,387 |
$68K |
| 81001 |
|
26,516 |
24,714 |
$68K |
| 96365 |
|
2,453 |
2,290 |
$66K |
| 93971 |
|
686 |
678 |
$65K |
| 83690 |
|
18,029 |
16,735 |
$65K |
| 87491 |
|
2,628 |
2,485 |
$60K |
| 87591 |
|
2,629 |
2,485 |
$60K |
| 84450 |
|
21,156 |
18,800 |
$59K |
| 82947 |
|
29,926 |
27,007 |
$57K |
| 84520 |
|
30,056 |
27,142 |
$55K |
| 0031A |
|
1,346 |
1,346 |
$54K |
| 84484 |
|
10,439 |
9,497 |
$53K |
| 73080 |
|
766 |
709 |
$52K |
| 78452 |
|
51 |
51 |
$48K |
| 84075 |
|
19,037 |
17,296 |
$47K |
| 70491 |
|
171 |
170 |
$46K |
| 86850 |
|
2,187 |
2,077 |
$46K |
| J1100 |
Dexamethasone sodium phos |
4,749 |
4,501 |
$46K |
| 73090 |
|
632 |
570 |
$46K |
| 72148 |
|
145 |
145 |
$44K |
| 0250 |
|
20,487 |
11,983 |
$43K |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
6,022 |
5,844 |
$43K |
| J7030 |
Normal saline solution infus |
9,858 |
8,341 |
$42K |
| 87636 |
|
607 |
603 |
$41K |
| J1885 |
Ketorolac tromethamine inj |
10,232 |
9,514 |
$41K |
| 72100 |
|
514 |
508 |
$40K |
| 84703 |
|
10,791 |
10,176 |
$38K |
| 86901 |
|
2,837 |
2,678 |
$38K |
| 76642 |
|
356 |
297 |
$37K |
| 70553 |
|
63 |
63 |
$33K |
| 83735 |
|
9,393 |
8,068 |
$32K |
| 87040 |
|
3,739 |
3,521 |
$31K |
| 70486 |
|
159 |
156 |
$29K |
| 73590 |
|
454 |
414 |
$29K |
| 73502 |
|
394 |
376 |
$28K |
| 81003 |
|
17,808 |
17,090 |
$28K |
| 80306 |
|
2,701 |
2,541 |
$27K |
| J2405 |
Ondansetron hcl injection |
5,895 |
5,285 |
$27K |
| 73140 |
|
435 |
410 |
$27K |
| 80048 |
|
6,696 |
6,263 |
$26K |
| 77067 |
|
250 |
249 |
$25K |
| 70496 |
|
92 |
92 |
$25K |
| 87088 |
|
6,506 |
6,261 |
$25K |
| 73564 |
|
244 |
168 |
$24K |
| 0011A |
|
590 |
590 |
$24K |
| 85652 |
|
8,101 |
7,746 |
$22K |
| 83605 |
|
3,495 |
3,206 |
$21K |
| 0012A |
|
512 |
512 |
$20K |
| 82570 |
|
3,109 |
2,898 |
$20K |
| J3490 |
Drugs unclassified injection |
3,411 |
2,683 |
$19K |
| 96360 |
|
802 |
775 |
$19K |
| J0696 |
Ceftriaxone sodium injection |
2,579 |
2,419 |
$19K |
| 93970 |
|
137 |
136 |
$18K |
| 70498 |
|
67 |
67 |
$16K |
| J2270 |
Morphine sulfate injection |
2,328 |
1,991 |
$16K |
| 85610 |
|
7,223 |
6,270 |
$16K |
| 0710 |
|
1,755 |
1,724 |
$15K |
| 82077 |
|
1,840 |
1,709 |
$13K |
| 99199 |
|
253 |
230 |
$13K |
| 84100 |
|
5,171 |
4,546 |
$13K |
| 77080 |
|
231 |
231 |
$13K |
| 82248 |
|
2,497 |
1,721 |
$12K |
| J7120 |
Ringers lactate infusion |
4,413 |
4,044 |
$12K |
| 84156 |
|
3,144 |
2,910 |
$12K |
| 76770 |
|
101 |
101 |
$12K |
| 76870 |
|
97 |
96 |
$11K |
| 71250 |
|
75 |
75 |
$11K |
| 72040 |
|
138 |
136 |
$11K |
| 97530 |
|
202 |
146 |
$10K |
| 85379 |
|
2,301 |
2,243 |
$10K |
| 0637 |
|
39,237 |
17,624 |
$10K |
| 85027 |
|
2,270 |
2,014 |
$9K |
| 73721 |
|
26 |
24 |
$9K |
| J1170 |
Hydromorphone injection |
1,808 |
1,488 |
$9K |
| 87502 |
|
186 |
185 |
$9K |
| 86140 |
|
2,928 |
2,749 |
$8K |
| 93306 |
|
25 |
25 |
$8K |
| 80179 |
|
1,113 |
1,048 |
$8K |
| 82310 |
|
1,509 |
1,088 |
$8K |
| 84132 |
|
1,710 |
1,222 |
$8K |
| 87449 |
|
590 |
576 |
$7K |
| 87210 |
|
1,681 |
1,659 |
$7K |
| 87324 |
|
544 |
533 |
$7K |
| 85378 |
|
1,324 |
1,267 |
$6K |
| 84443 |
|
927 |
919 |
$6K |
| 73552 |
|
93 |
82 |
$6K |
| J1200 |
Diphenhydramine hcl injectio |
2,061 |
1,899 |
$6K |
| J2765 |
Metoclopramide hcl injection |
2,136 |
1,956 |
$5K |
| 82962 |
|
3,445 |
2,843 |
$5K |
| 76857 |
|
54 |
53 |
$5K |
| Z7502 |
|
497 |
461 |
$5K |
| 82272 |
|
1,118 |
1,097 |
$4K |
| 72131 |
|
42 |
41 |
$4K |
| 77065 |
Tomosynthesis, mammo |
37 |
37 |
$4K |
| 97110 |
|
82 |
36 |
$4K |
| 96376 |
|
417 |
360 |
$4K |
| A9575 |
Inj gadoterate meglumi 0.1ml |
248 |
246 |
$4K |
| J2274 |
Inj morphine pf epid ithc |
228 |
189 |
$4K |
| A9502 |
Tc99m tetrofosmin |
51 |
51 |
$4K |
| S0119 |
Ondansetron 4 mg |
1,699 |
1,667 |
$4K |
| 99070 |
|
284 |
170 |
$4K |
| J3475 |
Inj magnesium sulfate |
1,150 |
1,106 |
$3K |
| 12001 |
|
133 |
132 |
$3K |
| 73060 |
|
43 |
38 |
$3K |
| 96366 |
|
278 |
268 |
$3K |
| 90715 |
|
95 |
94 |
$2K |
| 82803 |
|
368 |
354 |
$2K |
| 74022 |
|
42 |
41 |
$2K |
| 97165 |
|
25 |
25 |
$2K |
| 82550 |
|
646 |
621 |
$2K |
| 84295 |
|
491 |
347 |
$2K |
| 83615 |
|
383 |
359 |
$2K |
| 82040 |
|
520 |
435 |
$2K |
| J0780 |
Prochlorperazine injection |
389 |
371 |
$2K |
| J0690 |
Cefazolin sodium injection |
1,050 |
957 |
$2K |
| 77066 |
Tomosynthesis, mammo |
13 |
13 |
$2K |
| 76882 |
|
23 |
15 |
$2K |
| J2785 |
Regadenoson injection |
25 |
25 |
$2K |
| 87389 |
|
140 |
139 |
$2K |
| J1815 |
Insulin injection |
502 |
270 |
$2K |
| J2060 |
Lorazepam injection |
465 |
403 |
$1K |
| J3010 |
Fentanyl citrate injection |
898 |
839 |
$1K |
| 72170 |
|
16 |
15 |
$1K |
| 84550 |
|
378 |
365 |
$1K |
| 0636 |
|
77 |
77 |
$1K |
| 97112 |
|
20 |
13 |
$1K |
| 85007 |
|
767 |
648 |
$1K |
| 94640 |
|
85 |
69 |
$1K |
| 71101 |
|
13 |
12 |
$907.03 |
| 87633 |
|
13 |
13 |
$740.94 |
| 88305 |
|
16 |
16 |
$718.92 |
| 86780 |
|
83 |
83 |
$700.74 |
| 90471 |
|
229 |
219 |
$677.54 |
| 90686 |
|
50 |
50 |
$635.33 |
| 0272 |
|
26 |
25 |
$584.00 |
| 29125 |
|
82 |
81 |
$501.56 |
| A9585 |
Gadobutrol injection |
26 |
26 |
$488.22 |
| J1644 |
Inj heparin sodium per 1000u |
108 |
62 |
$482.65 |
| J2250 |
Inj midazolam hydrochloride |
1,095 |
1,074 |
$478.08 |
| 83036 |
|
203 |
197 |
$461.16 |
| 0370 |
|
1,475 |
1,450 |
$365.54 |
| 90656 |
|
47 |
47 |
$242.30 |
| 88304 |
|
69 |
68 |
$234.57 |
| 86665 |
|
12 |
12 |
$232.44 |
| J0136 |
Inj, acetaminophen (b braun) |
17 |
17 |
$223.86 |
| 85730 |
|
42 |
41 |
$219.11 |
| 10060 |
|
13 |
12 |
$165.00 |
| J1940 |
Furosemide injection |
38 |
26 |
$154.58 |
| T1999 |
Noc retail items andsupplies |
133 |
65 |
$136.81 |
| Q0144 |
Azithromycin dihydrate, oral |
38 |
38 |
$129.44 |
| 80178 |
|
24 |
24 |
$110.00 |
| 86664 |
|
12 |
12 |
$100.42 |
| 12011 |
|
14 |
14 |
$90.00 |
| 87070 |
|
13 |
13 |
$75.10 |
| 84155 |
|
40 |
38 |
$71.87 |
| J2001 |
Lidocaine injection |
19 |
19 |
$66.87 |
| J8540 |
Oral dexamethasone |
71 |
62 |
$53.16 |
| 96367 |
|
13 |
13 |
$39.37 |
| J2470 |
Inj pantoprazole sodium 40mg |
16 |
12 |
$38.60 |
| 83930 |
|
13 |
12 |
$36.51 |
| J2930 |
Methylprednisolone injection |
16 |
15 |
$30.57 |
| 76000 |
|
12 |
12 |
$23.21 |
| J7512 |
Prednisone ir or dr oral 1mg |
77 |
74 |
$21.85 |
| J2919 |
Inj, methylpred sod succ 5mg |
16 |
12 |
$14.71 |
| 0258 |
|
300 |
248 |
$0.00 |
| 80349 |
|
14 |
12 |
$0.00 |
| G0008 |
Admin influenza virus vac |
38 |
38 |
$0.00 |
| Z7610 |
|
42 |
13 |
$0.00 |
| 80320 |
|
12 |
12 |
$0.00 |
| 76376 |
|
150 |
149 |
$0.00 |
| C1713 |
Anchor/screw bn/bn,tis/bn |
13 |
13 |
$0.00 |