| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 11042 |
|
1,051 |
440 |
$96K |
| 87636 |
|
805 |
654 |
$54K |
| 80053 |
|
4,143 |
3,096 |
$48K |
| 70450 |
|
707 |
590 |
$48K |
| 97110 |
|
1,730 |
395 |
$40K |
| 80307 |
|
999 |
564 |
$40K |
| 74177 |
|
351 |
290 |
$36K |
| 87428 |
|
795 |
670 |
$27K |
| 85025 |
|
4,275 |
3,124 |
$20K |
| J1100 |
Dexamethasone sodium phos |
1,597 |
1,076 |
$19K |
| 76805 |
|
530 |
451 |
$17K |
| 72148 |
|
142 |
129 |
$15K |
| 59025 |
|
119 |
57 |
$14K |
| 71045 |
|
1,929 |
1,595 |
$13K |
| 74176 |
|
254 |
210 |
$13K |
| 99283 |
|
831 |
627 |
$12K |
| 93005 |
|
1,712 |
1,319 |
$12K |
| 80050 |
|
231 |
229 |
$11K |
| 80048 |
|
1,080 |
754 |
$11K |
| 97161 |
|
209 |
143 |
$9K |
| 77067 |
|
218 |
136 |
$8K |
| 83880 |
|
495 |
396 |
$8K |
| J2405 |
Ondansetron hcl injection |
1,534 |
1,025 |
$8K |
| 81001 |
|
3,051 |
2,294 |
$8K |
| 99284 |
|
748 |
599 |
$8K |
| 99285 |
|
444 |
370 |
$7K |
| 80061 |
|
940 |
647 |
$7K |
| 84484 |
|
1,068 |
716 |
$6K |
| 71046 |
|
502 |
394 |
$6K |
| 72125 |
|
72 |
66 |
$6K |
| 71275 |
|
36 |
32 |
$5K |
| 83036 |
|
838 |
613 |
$5K |
| J0696 |
Ceftriaxone sodium injection |
530 |
402 |
$5K |
| 82306 |
|
309 |
198 |
$5K |
| J1885 |
Ketorolac tromethamine inj |
1,382 |
963 |
$5K |
| 83735 |
|
1,318 |
994 |
$5K |
| 97530 |
|
192 |
77 |
$5K |
| 96372 |
|
439 |
322 |
$5K |
| 87086 |
|
847 |
661 |
$5K |
| 85027 |
|
1,021 |
711 |
$4K |
| 42820 |
|
28 |
12 |
$4K |
| 87430 |
|
448 |
377 |
$4K |
| 73721 |
|
25 |
16 |
$4K |
| 81025 |
|
659 |
544 |
$4K |
| 86403 |
|
371 |
314 |
$4K |
| 86901 |
|
225 |
140 |
$4K |
| 83690 |
|
644 |
514 |
$3K |
| 84443 |
|
912 |
648 |
$3K |
| 96374 |
|
522 |
392 |
$3K |
| 36416 |
|
342 |
180 |
$3K |
| 83655 |
|
240 |
173 |
$3K |
| 74018 |
|
233 |
168 |
$3K |
| G0463 |
Hospital outpt clinic visit |
411 |
239 |
$3K |
| 76801 |
|
70 |
63 |
$2K |
| 87426 |
|
81 |
73 |
$2K |
| 82962 |
|
826 |
327 |
$2K |
| 41899 |
|
102 |
82 |
$2K |
| 87077 |
|
388 |
314 |
$2K |
| 96365 |
|
80 |
56 |
$2K |
| 73630 |
|
91 |
79 |
$2K |
| 87040 |
|
203 |
97 |
$2K |
| 84439 |
|
276 |
171 |
$2K |
| 88305 |
|
133 |
80 |
$2K |
| 96375 |
|
299 |
232 |
$2K |
| 88304 |
|
122 |
61 |
$1K |
| 83605 |
|
154 |
111 |
$1K |
| 36415 |
|
2,402 |
1,776 |
$1K |
| 94640 |
|
363 |
199 |
$1K |
| 87804 |
|
124 |
79 |
$1K |
| 73610 |
|
97 |
80 |
$1K |
| 86850 |
|
164 |
99 |
$1K |
| 84703 |
|
233 |
148 |
$1K |
| 85610 |
|
368 |
267 |
$1K |
| 87186 |
|
229 |
178 |
$776.07 |
| 86900 |
|
224 |
140 |
$726.76 |
| 94760 |
|
115 |
41 |
$672.00 |
| 36600 |
|
17 |
14 |
$660.46 |
| 85730 |
|
184 |
148 |
$648.40 |
| 82803 |
|
54 |
39 |
$582.72 |
| 81003 |
|
437 |
300 |
$567.38 |
| 86140 |
|
120 |
94 |
$492.91 |
| 87491 |
|
19 |
13 |
$451.08 |
| 85379 |
|
51 |
47 |
$450.43 |
| 72100 |
|
29 |
29 |
$438.76 |
| 99281 |
|
18 |
15 |
$403.19 |
| 84702 |
|
46 |
29 |
$361.21 |
| J0690 |
Cefazolin sodium injection |
453 |
269 |
$320.13 |
| 76856 |
|
14 |
14 |
$320.00 |
| 73562 |
|
12 |
12 |
$315.00 |
| C9803 |
Hopd covid-19 spec collect |
341 |
271 |
$299.11 |
| J2270 |
Morphine sulfate injection |
699 |
422 |
$274.98 |
| 82805 |
|
19 |
15 |
$245.56 |
| 73030 |
|
17 |
14 |
$221.80 |
| J3010 |
Fentanyl citrate injection |
748 |
492 |
$220.21 |
| 90715 |
|
13 |
12 |
$201.60 |
| J2704 |
Inj, propofol, 10 mg |
1,201 |
744 |
$199.62 |
| 96361 |
|
21 |
12 |
$178.37 |
| 82607 |
|
15 |
13 |
$177.97 |
| 87070 |
|
51 |
48 |
$147.60 |
| J1650 |
Inj enoxaparin sodium |
29 |
13 |
$141.28 |
| 88312 |
|
31 |
15 |
$117.00 |
| 83540 |
|
32 |
14 |
$111.00 |
| 82150 |
|
28 |
12 |
$92.60 |
| 90471 |
|
13 |
12 |
$91.98 |
| J2250 |
Inj midazolam hydrochloride |
474 |
305 |
$72.44 |
| J1200 |
Diphenhydramine hcl injectio |
132 |
91 |
$56.34 |
| 87205 |
|
29 |
28 |
$48.80 |
| J2550 |
Promethazine hcl injection |
78 |
53 |
$44.99 |
| Q0162 |
Ondansetron oral |
570 |
459 |
$39.67 |
| J0330 |
Succinycholine chloride inj |
49 |
27 |
$23.90 |
| J2765 |
Metoclopramide hcl injection |
31 |
25 |
$16.04 |
| J1171 |
Inj, hydromorphone, 0.1 mg |
13 |
12 |
$10.80 |
| J7030 |
Normal saline solution infus |
464 |
331 |
$6.75 |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
711 |
594 |
$5.44 |
| J1170 |
Hydromorphone injection |
365 |
227 |
$0.00 |
| J0131 |
Inj, acetaminophen (nos) |
48 |
27 |
$0.00 |
| J0360 |
Hydralazine hcl injection |
75 |
59 |
$0.00 |
| G0283 |
Elec stim other than wound |
197 |
56 |
$0.00 |
| J0780 |
Prochlorperazine injection |
19 |
16 |
$0.00 |