| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 69436 |
|
759 |
758 |
$1.45M |
| 42820 |
|
715 |
713 |
$1.37M |
| 70553 |
|
2,501 |
2,498 |
$1.22M |
| 70551 |
|
683 |
683 |
$342K |
| 77067 |
|
2,173 |
2,173 |
$204K |
| 54161 |
|
151 |
151 |
$200K |
| 42830 |
|
91 |
91 |
$160K |
| 88304 |
|
1,641 |
1,636 |
$66K |
| 92526 |
|
395 |
174 |
$56K |
| 88305 |
|
1,024 |
1,009 |
$42K |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
1,430 |
1,419 |
$33K |
| 74177 |
|
413 |
404 |
$31K |
| 71045 |
|
2,705 |
1,859 |
$24K |
| 77063 |
|
2,101 |
2,100 |
$23K |
| 77066 |
Tomosynthesis, mammo |
136 |
136 |
$13K |
| 76642 |
|
445 |
413 |
$13K |
| A9575 |
Inj gadoterate meglumi 0.1ml |
1,829 |
1,826 |
$13K |
| 77065 |
Tomosynthesis, mammo |
99 |
92 |
$12K |
| 71046 |
|
1,047 |
1,027 |
$12K |
| 88307 |
|
124 |
123 |
$11K |
| 72148 |
|
24 |
24 |
$11K |
| J3490 |
Drugs unclassified injection |
654 |
603 |
$10K |
| 76641 |
|
243 |
243 |
$9K |
| 77049 |
|
13 |
13 |
$7K |
| 81025 |
|
1,522 |
1,509 |
$7K |
| 74183 |
|
12 |
12 |
$6K |
| 72141 |
|
12 |
12 |
$6K |
| 70450 |
|
140 |
134 |
$6K |
| 77062 |
|
77 |
77 |
$5K |
| 76700 |
|
101 |
101 |
$4K |
| 71260 |
|
24 |
24 |
$4K |
| 76705 |
|
124 |
122 |
$3K |
| 36415 |
|
918 |
882 |
$3K |
| 71250 |
|
27 |
27 |
$3K |
| A9585 |
Gadobutrol injection |
1,595 |
1,586 |
$3K |
| 77080 |
|
37 |
37 |
$2K |
| 84443 |
|
149 |
148 |
$2K |
| 92610 |
|
13 |
13 |
$2K |
| 82306 |
|
59 |
57 |
$2K |
| 74178 |
|
13 |
12 |
$2K |
| 82570 |
|
205 |
146 |
$2K |
| 83970 |
|
30 |
28 |
$2K |
| 80069 |
|
89 |
84 |
$1K |
| 82043 |
|
147 |
134 |
$1K |
| 80053 |
|
58 |
57 |
$1K |
| 76536 |
|
38 |
38 |
$1K |
| J7030 |
Normal saline solution infus |
840 |
799 |
$999.48 |
| 74018 |
|
95 |
83 |
$871.47 |
| 87086 |
|
83 |
79 |
$821.86 |
| 83036 |
|
44 |
44 |
$649.42 |
| 85025 |
|
107 |
105 |
$503.62 |
| 81001 |
|
71 |
70 |
$318.78 |
| J2704 |
Inj, propofol, 10 mg |
5,583 |
5,553 |
$305.83 |
| J2405 |
Ondansetron hcl injection |
5,656 |
5,619 |
$202.31 |
| 84439 |
|
13 |
13 |
$198.00 |
| 81003 |
|
58 |
56 |
$179.38 |
| 80061 |
|
18 |
18 |
$167.65 |
| 84156 |
|
30 |
27 |
$160.24 |
| 85027 |
|
17 |
16 |
$87.73 |
| J1596 |
Inj, glycopyrrolate, 0.1 mg |
333 |
333 |
$20.31 |
| J1885 |
Ketorolac tromethamine inj |
4,351 |
4,304 |
$20.24 |
| J7050 |
Normal saline solution infus |
49 |
49 |
$19.27 |
| J0690 |
Cefazolin sodium injection |
1,287 |
1,274 |
$18.69 |
| J1170 |
Hydromorphone injection |
1,619 |
1,606 |
$16.76 |
| J0171 |
Adrenalin epinephrine inject |
347 |
330 |
$15.20 |
| J1100 |
Dexamethasone sodium phos |
4,935 |
4,861 |
$14.88 |
| J2250 |
Inj midazolam hydrochloride |
3,711 |
3,690 |
$11.99 |
| J0330 |
Succinycholine chloride inj |
74 |
74 |
$6.60 |
| J3010 |
Fentanyl citrate injection |
4,459 |
4,442 |
$6.21 |
| J0665 |
Inj, bupivacaine, nos, 0.5mg |
619 |
503 |
$5.58 |
| J7999 |
Compounded drug, noc |
296 |
295 |
$4.76 |
| J8499 |
Oral prescrip drug non chemo |
63 |
58 |
$4.76 |
| J2270 |
Morphine sulfate injection |
536 |
531 |
$4.64 |
| J2003 |
Inj, lidocaine hcl, 1 mg |
25 |
25 |
$0.81 |
| J2001 |
Lidocaine injection |
95 |
87 |
$0.21 |
| J2795 |
Ropivacaine hcl injection |
15 |
15 |
$0.00 |
| 72020 |
|
13 |
13 |
$0.00 |
| A4216 |
Sterile water/saline, 10 ml |
63 |
63 |
$0.00 |
| J2272 |
Inj, morphine (fresenius) |
55 |
55 |
$0.00 |
| J1200 |
Diphenhydramine hcl injectio |
56 |
56 |
$0.00 |
| J1171 |
Inj, hydromorphone, 0.1 mg |
46 |
45 |
$0.00 |
| J2710 |
Neostigmine methylslfte inj |
14 |
14 |
$0.00 |
| G1004 |
Cdsm ndsc |
60 |
59 |
$0.00 |