| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 74176 |
|
2,659 |
2,252 |
$2.79M |
| 99283 |
|
8,149 |
7,097 |
$2.12M |
| 99284 |
|
5,213 |
4,399 |
$1.98M |
| 70450 |
|
2,074 |
1,757 |
$1.04M |
| 99282 |
|
7,179 |
6,109 |
$1.03M |
| 99285 |
|
2,485 |
1,867 |
$1.02M |
| 74177 |
|
298 |
273 |
$519K |
| 96372 |
|
6,025 |
4,159 |
$398K |
| 97110 |
|
9,297 |
1,673 |
$333K |
| 80053 |
|
13,250 |
10,631 |
$314K |
| 96361 |
|
1,880 |
1,423 |
$314K |
| 71046 |
|
3,020 |
2,564 |
$269K |
| 93005 |
|
3,124 |
2,563 |
$267K |
| 36415 |
|
37,801 |
18,647 |
$230K |
| 96374 |
|
2,253 |
1,807 |
$228K |
| 87426 |
|
4,394 |
3,398 |
$200K |
| 96375 |
|
1,732 |
1,360 |
$180K |
| 85025 |
|
11,233 |
9,617 |
$180K |
| 93306 |
|
226 |
171 |
$169K |
| 87428 |
|
3,067 |
2,646 |
$163K |
| 71045 |
|
2,645 |
2,140 |
$159K |
| 96365 |
|
975 |
658 |
$153K |
| 99281 |
|
1,568 |
1,399 |
$147K |
| 84443 |
|
3,488 |
3,102 |
$132K |
| 71250 |
|
209 |
145 |
$105K |
| 80061 |
|
3,930 |
3,517 |
$97K |
| 80306 |
|
2,136 |
1,772 |
$95K |
| 73630 |
|
871 |
695 |
$92K |
| 84484 |
|
2,673 |
2,112 |
$92K |
| 82306 |
|
1,528 |
1,331 |
$85K |
| 77067 |
|
575 |
545 |
$83K |
| 92507 |
|
2,280 |
582 |
$82K |
| J1885 |
Ketorolac tromethamine inj |
4,159 |
3,018 |
$74K |
| 72110 |
|
428 |
368 |
$71K |
| 97530 |
|
880 |
261 |
$69K |
| 81001 |
|
4,970 |
4,282 |
$64K |
| 83874 |
|
1,759 |
1,436 |
$62K |
| 82553 |
|
1,719 |
1,401 |
$56K |
| 73130 |
|
535 |
427 |
$53K |
| 73562 |
|
566 |
458 |
$52K |
| J7030 |
Normal saline solution infus |
2,411 |
1,617 |
$44K |
| 83036 |
|
2,722 |
2,439 |
$40K |
| 73030 |
|
401 |
315 |
$37K |
| 85379 |
|
858 |
739 |
$36K |
| 87804 |
|
890 |
776 |
$36K |
| 80048 |
|
2,455 |
1,883 |
$35K |
| 94640 |
|
343 |
278 |
$35K |
| 83690 |
|
2,405 |
2,023 |
$34K |
| 81025 |
|
1,743 |
1,514 |
$30K |
| 73610 |
|
266 |
224 |
$27K |
| 73110 |
|
237 |
160 |
$25K |
| 87070 |
|
1,314 |
1,070 |
$24K |
| J2405 |
Ondansetron hcl injection |
2,517 |
1,678 |
$24K |
| 82150 |
|
2,163 |
1,848 |
$23K |
| 85027 |
|
1,978 |
1,440 |
$22K |
| 87430 |
|
1,249 |
1,077 |
$21K |
| 97112 |
|
636 |
136 |
$19K |
| 77063 |
|
323 |
283 |
$19K |
| 83880 |
|
382 |
292 |
$19K |
| 80178 |
|
1,001 |
865 |
$18K |
| 86756 |
|
694 |
587 |
$18K |
| J3490 |
Drugs unclassified injection |
2,144 |
1,114 |
$16K |
| 96360 |
|
97 |
74 |
$15K |
| J7120 |
Ringers lactate infusion |
595 |
438 |
$13K |
| 81003 |
|
1,384 |
1,191 |
$11K |
| 82607 |
|
493 |
460 |
$9K |
| A4216 |
Sterile water/saline, 10 ml |
1,490 |
942 |
$8K |
| M0243 |
Casirivi and imdevi inj |
24 |
19 |
$7K |
| 0012A |
|
247 |
232 |
$7K |
| G0307 |
Cbc without platelet |
428 |
382 |
$7K |
| 87086 |
|
735 |
412 |
$7K |
| Q0162 |
Ondansetron oral |
244 |
218 |
$5K |
| 72050 |
|
26 |
24 |
$5K |
| P9604 |
One-way allow prorated trip |
8,735 |
3,309 |
$5K |
| 87635 |
|
134 |
113 |
$5K |
| 84480 |
|
177 |
175 |
$4K |
| 84436 |
|
445 |
395 |
$4K |
| 0011A |
|
240 |
221 |
$4K |
| 93356 |
|
80 |
71 |
$4K |
| 83550 |
|
371 |
347 |
$4K |
| 83735 |
|
342 |
308 |
$4K |
| 84439 |
|
268 |
265 |
$4K |
| 87077 |
|
382 |
235 |
$4K |
| 76705 |
|
12 |
12 |
$4K |
| J7050 |
Normal saline solution infus |
411 |
258 |
$3K |
| 83540 |
|
385 |
357 |
$3K |
| 85610 |
|
268 |
203 |
$3K |
| 80164 |
|
214 |
174 |
$3K |
| 80050 |
|
72 |
71 |
$3K |
| 87040 |
|
68 |
64 |
$2K |
| J0696 |
Ceftriaxone sodium injection |
290 |
163 |
$2K |
| 74022 |
|
13 |
12 |
$2K |
| J2704 |
Inj, propofol, 10 mg |
95 |
81 |
$2K |
| 80320 |
|
76 |
62 |
$2K |
| J2930 |
Methylprednisolone injection |
111 |
67 |
$2K |
| 80305 |
|
171 |
155 |
$2K |
| 73564 |
|
12 |
12 |
$1K |
| J2270 |
Morphine sulfate injection |
84 |
40 |
$1K |
| G2023 |
Specimen collect covid-19 |
53 |
42 |
$1K |
| P9603 |
One-way allow prorated miles |
6,775 |
1,319 |
$864.83 |
| 82803 |
|
17 |
14 |
$825.05 |
| J2360 |
Orphenadrine injection |
28 |
26 |
$727.63 |
| 84703 |
|
41 |
39 |
$699.32 |
| J3301 |
Triamcinolone acet inj nos |
32 |
25 |
$690.43 |
| 90471 |
|
39 |
33 |
$626.92 |
| 90686 |
|
19 |
17 |
$584.22 |
| J1100 |
Dexamethasone sodium phos |
82 |
78 |
$422.75 |
| 36600 |
|
17 |
14 |
$397.76 |
| J2250 |
Inj midazolam hydrochloride |
30 |
15 |
$379.10 |
| 83986 |
|
33 |
30 |
$337.99 |
| J7620 |
Albuterol ipratrop non-comp |
73 |
53 |
$304.38 |
| J2550 |
Promethazine hcl injection |
27 |
24 |
$256.91 |
| J1200 |
Diphenhydramine hcl injectio |
26 |
26 |
$203.16 |
| J3010 |
Fentanyl citrate injection |
14 |
13 |
$190.78 |
| 83605 |
|
12 |
12 |
$177.67 |
| 87186 |
|
14 |
12 |
$157.87 |
| J7613 |
Albuterol non-comp unit |
55 |
47 |
$107.60 |
| J7510 |
Prednisolone oral per 5 mg |
14 |
13 |
$93.89 |
| 82570 |
|
14 |
12 |
$83.93 |
| J8540 |
Oral dexamethasone |
12 |
12 |
$53.81 |
| J2001 |
Lidocaine injection |
39 |
36 |
$30.42 |
| J2003 |
Inj, lidocaine hcl, 1 mg |
13 |
13 |
$8.24 |
| 91301 |
|
192 |
186 |
$0.79 |