| Code | Description | Claims | Beneficiaries | Total Paid |
| 0121 |
|
101 |
99 |
$1.22M |
| 0214 |
|
115 |
110 |
$1.20M |
| 0122 |
|
32 |
32 |
$237K |
| 0450 |
|
4,222 |
3,748 |
$224K |
| 0123 |
|
13 |
13 |
$101K |
| J3490 |
Drugs unclassified injection |
3,094 |
1,462 |
$45K |
| 96374 |
|
433 |
395 |
$38K |
| 0762 |
|
189 |
104 |
$32K |
| 74177 |
|
73 |
72 |
$25K |
| 93005 |
|
674 |
607 |
$22K |
| 96375 |
|
324 |
276 |
$20K |
| 70450 |
|
105 |
104 |
$19K |
| Z7502 |
|
472 |
469 |
$18K |
| 80307 |
|
154 |
141 |
$14K |
| 80053 |
|
1,055 |
959 |
$12K |
| 93306 |
|
42 |
41 |
$12K |
| T1999 |
Noc retail items andsupplies |
367 |
208 |
$11K |
| 85025 |
|
1,281 |
1,109 |
$11K |
| 96361 |
|
201 |
180 |
$9K |
| 74176 |
|
50 |
48 |
$9K |
| 96365 |
|
71 |
69 |
$8K |
| 71046 |
|
422 |
410 |
$7K |
| 94640 |
|
252 |
226 |
$7K |
| 99284 |
|
123 |
99 |
$7K |
| 84484 |
|
534 |
383 |
$6K |
| 0171 |
Inj, epinephrine (belcher) |
32 |
32 |
$6K |
| 96360 |
|
67 |
64 |
$5K |
| 87491 |
|
112 |
108 |
$5K |
| 87591 |
|
112 |
108 |
$5K |
| 99283 |
|
87 |
84 |
$5K |
| 71275 |
|
17 |
16 |
$5K |
| 76705 |
|
79 |
74 |
$4K |
| 78452 |
|
13 |
13 |
$4K |
| 93971 |
|
26 |
25 |
$4K |
| 0360 |
|
64 |
54 |
$4K |
| 90715 |
|
61 |
60 |
$4K |
| 87502 |
|
32 |
32 |
$3K |
| 0510 |
|
82 |
67 |
$3K |
| 83690 |
|
399 |
367 |
$3K |
| 76801 |
|
44 |
42 |
$3K |
| J0500 |
Dicyclomine injection |
31 |
28 |
$3K |
| 71045 |
|
291 |
272 |
$3K |
| 83880 |
|
76 |
71 |
$3K |
| 99285 |
|
28 |
27 |
$3K |
| 82947 |
|
466 |
336 |
$3K |
| 87040 |
|
228 |
112 |
$3K |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
234 |
119 |
$3K |
| 83605 |
|
215 |
161 |
$2K |
| A9502 |
Tc99m tetrofosmin |
13 |
13 |
$2K |
| J7030 |
Normal saline solution infus |
200 |
178 |
$2K |
| J2405 |
Ondansetron hcl injection |
250 |
211 |
$2K |
| 76856 |
|
31 |
31 |
$2K |
| 29125 |
|
29 |
26 |
$2K |
| 83735 |
|
225 |
179 |
$2K |
| 81025 |
|
351 |
339 |
$2K |
| J1885 |
Ketorolac tromethamine inj |
198 |
184 |
$2K |
| 81001 |
|
426 |
407 |
$2K |
| 73610 |
|
65 |
63 |
$2K |
| Z9725 |
|
31 |
29 |
$1K |
| 80048 |
|
145 |
128 |
$1K |
| 99281 |
|
40 |
37 |
$1K |
| J1170 |
Hydromorphone injection |
120 |
90 |
$1K |
| J2270 |
Morphine sulfate injection |
132 |
101 |
$1K |
| 73030 |
|
40 |
37 |
$1K |
| J1100 |
Dexamethasone sodium phos |
129 |
126 |
$1K |
| 84702 |
|
73 |
65 |
$1K |
| 73130 |
|
51 |
46 |
$1K |
| 87400 |
|
166 |
162 |
$1K |
| 87086 |
|
106 |
103 |
$1K |
| 94644 |
|
35 |
31 |
$990.06 |
| 73630 |
|
42 |
41 |
$985.37 |
| 73562 |
|
45 |
45 |
$936.43 |
| 73110 |
|
37 |
36 |
$922.41 |
| 84443 |
|
46 |
44 |
$921.52 |
| J3010 |
Fentanyl citrate injection |
78 |
69 |
$905.33 |
| 96366 |
|
19 |
18 |
$844.37 |
| 84703 |
|
122 |
118 |
$842.23 |
| 85730 |
|
106 |
102 |
$760.91 |
| J0696 |
Ceftriaxone sodium injection |
83 |
80 |
$730.12 |
| 85379 |
|
53 |
52 |
$689.04 |
| J0780 |
Prochlorperazine injection |
26 |
26 |
$644.36 |
| 0710 |
|
57 |
57 |
$623.31 |
| 85610 |
|
142 |
133 |
$619.97 |
| J2765 |
Metoclopramide hcl injection |
82 |
75 |
$618.45 |
| J2001 |
Lidocaine injection |
74 |
74 |
$603.47 |
| J1200 |
Diphenhydramine hcl injectio |
78 |
66 |
$594.00 |
| 87880 |
|
68 |
68 |
$581.82 |
| 82550 |
|
63 |
55 |
$544.76 |
| 73080 |
|
15 |
15 |
$509.42 |
| 87186 |
|
53 |
47 |
$508.08 |
| 73140 |
|
31 |
31 |
$487.29 |
| 87077 |
|
53 |
45 |
$460.46 |
| 82805 |
|
17 |
14 |
$444.42 |
| 82553 |
|
23 |
20 |
$403.94 |
| J3475 |
Inj magnesium sulfate |
41 |
36 |
$357.18 |
| J2060 |
Lorazepam injection |
47 |
41 |
$352.86 |
| 83036 |
|
26 |
25 |
$329.48 |
| 10060 |
|
12 |
12 |
$309.84 |
| J2930 |
Methylprednisolone injection |
23 |
19 |
$286.58 |
| S0164 |
Injection pantroprazole |
16 |
15 |
$278.00 |
| 87210 |
|
70 |
68 |
$256.13 |
| J7050 |
Normal saline solution infus |
27 |
25 |
$248.73 |
| J2250 |
Inj midazolam hydrochloride |
31 |
27 |
$221.52 |
| J1644 |
Inj heparin sodium per 1000u |
31 |
14 |
$218.10 |
| 84100 |
|
44 |
38 |
$214.05 |
| 0430 |
|
14 |
14 |
$209.88 |
| J2704 |
Inj, propofol, 10 mg |
20 |
13 |
$209.67 |
| 86901 |
|
60 |
54 |
$193.97 |
| 80061 |
|
14 |
13 |
$183.64 |
| Z7610 |
|
22 |
12 |
$176.28 |
| 0320 |
|
33 |
33 |
$143.82 |
| 86900 |
|
41 |
33 |
$123.73 |
| 86140 |
|
15 |
14 |
$98.34 |
| 82009 |
|
17 |
15 |
$87.65 |
| 90471 |
|
13 |
13 |
$86.70 |
| 0250 |
|
319 |
298 |
$67.52 |
| J7510 |
Prednisolone oral per 5 mg |
12 |
12 |
$64.54 |
| 86850 |
|
13 |
12 |
$49.40 |
| J7620 |
Albuterol ipratrop non-comp |
177 |
161 |
$3.67 |
| 36415 |
|
140 |
118 |
$3.38 |
| 0302 |
|
76 |
76 |
$0.00 |
| 0460 |
|
47 |
46 |
$0.00 |
| 0412 |
|
92 |
85 |
$0.00 |
| 0351 |
|
18 |
18 |
$0.00 |
| 0300 |
|
237 |
227 |
$0.00 |
| 0272 |
|
106 |
105 |
$0.00 |
| 0730 |
|
144 |
136 |
$0.00 |
| 0402 |
|
56 |
55 |
$0.00 |
| 0489 |
|
60 |
59 |
$0.00 |
| 0250R |
|
42 |
41 |
$0.00 |
| 0420 |
|
63 |
61 |
$0.00 |
| 0305 |
|
247 |
237 |
$0.00 |
| 0307 |
|
95 |
91 |
$0.00 |
| 0949 |
|
162 |
157 |
$0.00 |
| 0370 |
|
70 |
70 |
$0.00 |
| 0352 |
|
66 |
65 |
$0.00 |
| 0409 |
|
25 |
25 |
$0.00 |
| 0324 |
|
157 |
148 |
$0.00 |
| 0258 |
|
210 |
204 |
$0.00 |
| 0410 |
|
56 |
54 |
$0.00 |
| 0310 |
|
40 |
40 |
$0.00 |
| 0440 |
|
14 |
14 |
$0.00 |
| 0306 |
|
170 |
160 |
$0.00 |
| 0255 |
|
72 |
72 |
$0.00 |
| 0301 |
|
245 |
235 |
$0.00 |
| 0721 |
|
15 |
15 |
$0.00 |