| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99283 |
|
79,000 |
65,472 |
$12.60M |
| 99284 |
|
66,289 |
53,245 |
$10.57M |
| 96361 |
|
33,002 |
23,795 |
$9.17M |
| 99285 |
|
40,086 |
32,608 |
$6.71M |
| 99282 |
|
22,482 |
18,924 |
$3.26M |
| 74177 |
|
16,983 |
14,620 |
$3.04M |
| 97110 |
|
57,835 |
14,601 |
$2.79M |
| 70450 |
|
16,534 |
13,888 |
$2.65M |
| 92507 |
|
18,172 |
4,843 |
$2.31M |
| G0378 |
Hospital observation per hr |
7,587 |
5,757 |
$1.80M |
| 78815 |
|
1,763 |
1,604 |
$1.49M |
| 71275 |
|
6,055 |
5,289 |
$1.42M |
| 59025 |
|
6,057 |
4,644 |
$1.16M |
| 97530 |
|
24,858 |
7,850 |
$1.12M |
| 74176 |
|
5,691 |
4,888 |
$904K |
| 96360 |
|
8,220 |
7,115 |
$858K |
| 93306 |
|
3,341 |
2,959 |
$811K |
| 78452 |
|
1,330 |
1,154 |
$766K |
| 96366 |
|
3,375 |
2,203 |
$711K |
| 94640 |
|
13,404 |
8,252 |
$670K |
| 97161 |
|
6,608 |
5,844 |
$566K |
| 80307 |
|
10,948 |
9,237 |
$511K |
| J3490 |
Drugs unclassified injection |
330,919 |
79,232 |
$501K |
| 96365 |
|
5,996 |
5,190 |
$435K |
| 70553 |
|
1,388 |
1,254 |
$392K |
| 58661 |
|
123 |
91 |
$379K |
| 76642 |
|
3,782 |
2,949 |
$364K |
| 76705 |
|
4,211 |
3,710 |
$336K |
| 71260 |
|
3,689 |
3,239 |
$320K |
| 80048 |
|
93,595 |
67,108 |
$317K |
| 97162 |
|
3,135 |
2,812 |
$302K |
| 70551 |
|
1,679 |
1,470 |
$295K |
| 43239 |
|
531 |
466 |
$284K |
| 97140 |
|
21,490 |
6,693 |
$265K |
| 97112 |
|
10,767 |
3,388 |
$244K |
| G0463 |
Hospital outpt clinic visit |
17,421 |
11,507 |
$243K |
| 77063 |
|
6,251 |
5,894 |
$242K |
| 70491 |
|
1,277 |
1,163 |
$226K |
| 71046 |
|
37,745 |
32,036 |
$220K |
| 97597 |
|
4,386 |
1,914 |
$216K |
| 93971 |
|
2,972 |
2,505 |
$216K |
| 76830 |
|
3,155 |
2,794 |
$215K |
| 72148 |
|
1,420 |
1,267 |
$215K |
| 45380 |
|
227 |
209 |
$197K |
| 99281 |
|
1,335 |
1,196 |
$194K |
| 77067 |
|
7,312 |
6,838 |
$190K |
| 0240U |
|
3,475 |
3,208 |
$188K |
| 10060 |
|
1,651 |
1,427 |
$182K |
| 76801 |
|
4,126 |
3,391 |
$174K |
| 71250 |
|
3,011 |
2,610 |
$169K |
| 76856 |
|
3,220 |
2,851 |
$166K |
| 90935 |
|
648 |
334 |
$162K |
| 97598 |
|
357 |
114 |
$158K |
| 76770 |
|
1,495 |
1,331 |
$150K |
| 93970 |
|
1,501 |
1,255 |
$145K |
| P9016 |
Rbc leukocytes reduced |
572 |
428 |
$140K |
| 97116 |
|
4,444 |
1,721 |
$139K |
| 87635 |
|
2,520 |
2,150 |
$135K |
| 93005 |
|
57,227 |
46,321 |
$127K |
| 99213 |
|
1,339 |
1,016 |
$120K |
| 87591 |
|
14,237 |
12,558 |
$120K |
| 97165 |
|
1,972 |
1,688 |
$117K |
| 93017 |
|
1,793 |
1,545 |
$116K |
| 72125 |
|
3,863 |
3,294 |
$114K |
| 93976 |
|
2,575 |
2,265 |
$113K |
| 11042 |
|
855 |
482 |
$111K |
| 99291 |
|
468 |
416 |
$109K |
| 45378 |
|
115 |
108 |
$107K |
| 73721 |
|
591 |
514 |
$103K |
| 70496 |
|
537 |
476 |
$102K |
| G0283 |
Elec stim other than wound |
4,129 |
1,236 |
$101K |
| U0004 |
Cov-19 test non-cdc hgh thru |
5,469 |
4,761 |
$99K |
| 59050 |
|
668 |
505 |
$98K |
| 0241U |
|
1,312 |
1,182 |
$89K |
| 83880 |
|
11,707 |
9,551 |
$86K |
| 76817 |
|
3,957 |
3,247 |
$82K |
| 97535 |
|
3,155 |
2,198 |
$81K |
| 76536 |
|
859 |
776 |
$81K |
| 97016 |
|
2,983 |
828 |
$80K |
| 72141 |
|
420 |
386 |
$78K |
| C8929 |
Tte w or wo fol wcon,doppler |
281 |
259 |
$75K |
| 12001 |
|
349 |
331 |
$74K |
| 80047 |
|
21,502 |
18,416 |
$72K |
| C1713 |
Anchor/screw bn/bn,tis/bn |
1,392 |
1,182 |
$68K |
| 77065 |
Tomosynthesis, mammo |
2,069 |
1,688 |
$68K |
| 99214 |
|
789 |
672 |
$66K |
| 77066 |
Tomosynthesis, mammo |
2,178 |
1,943 |
$65K |
| 70486 |
|
1,376 |
1,233 |
$65K |
| 85025 |
|
98,426 |
73,233 |
$63K |
| 36430 |
|
467 |
333 |
$61K |
| 82962 |
|
32,891 |
12,002 |
$54K |
| 70498 |
|
521 |
460 |
$52K |
| 74178 |
|
234 |
220 |
$52K |
| 45385 |
|
86 |
82 |
$51K |
| 96374 |
|
50,285 |
40,302 |
$48K |
| 85379 |
|
11,232 |
9,866 |
$48K |
| 97760 |
|
1,188 |
1,029 |
$47K |
| 71045 |
|
15,670 |
12,819 |
$45K |
| 80076 |
|
29,613 |
24,309 |
$44K |
| 87636 |
|
5,744 |
5,274 |
$42K |
| 80053 |
|
8,713 |
7,089 |
$39K |
| 76942 |
|
920 |
754 |
$39K |
| U0002 |
Covid-19 lab test non-cdc |
4,542 |
4,293 |
$38K |
| 84484 |
|
38,580 |
22,583 |
$37K |
| 64415 |
|
203 |
180 |
$36K |
| 90715 |
|
2,262 |
2,019 |
$36K |
| 87661 |
|
9,881 |
8,761 |
$35K |
| 96375 |
|
35,167 |
26,291 |
$34K |
| 97750 |
|
1,203 |
727 |
$34K |
| G0279 |
Tomosynthesis, mammo |
2,709 |
2,413 |
$33K |
| 94060 |
|
700 |
629 |
$33K |
| 76815 |
|
587 |
500 |
$32K |
| 72110 |
|
2,420 |
2,119 |
$32K |
| 76700 |
|
252 |
229 |
$29K |
| 71271 |
|
302 |
291 |
$29K |
| 84703 |
|
20,156 |
17,537 |
$28K |
| 58558 |
|
15 |
14 |
$28K |
| 94726 |
|
988 |
889 |
$26K |
| 85027 |
|
14,288 |
10,873 |
$26K |
| 94729 |
|
1,198 |
1,069 |
$25K |
| 87040 |
|
5,737 |
2,663 |
$25K |
| 97113 |
|
516 |
188 |
$24K |
| 99212 |
|
323 |
294 |
$24K |
| 73630 |
|
5,699 |
4,432 |
$24K |
| 73030 |
|
3,955 |
3,246 |
$23K |
| J3010 |
Fentanyl citrate injection |
12,705 |
9,644 |
$23K |
| 96372 |
|
25,724 |
15,553 |
$23K |
| 73564 |
|
4,601 |
3,630 |
$23K |
| 77080 |
|
408 |
359 |
$21K |
| 88305 |
|
5,333 |
4,499 |
$21K |
| 96376 |
|
17,515 |
8,859 |
$21K |
| G0480 |
Drug test def 1-7 classes |
2,834 |
1,924 |
$20K |
| 97166 |
|
191 |
167 |
$20K |
| 12002 |
|
145 |
123 |
$19K |
| 88307 |
|
1,139 |
965 |
$19K |
| C1729 |
Cath, drainage |
3,012 |
2,373 |
$17K |
| 73130 |
|
3,427 |
2,687 |
$17K |
| 73502 |
|
2,483 |
2,052 |
$17K |
| 49083 |
|
24 |
12 |
$17K |
| 87502 |
|
1,276 |
1,117 |
$16K |
| 29581 |
|
119 |
25 |
$16K |
| 74183 |
|
55 |
50 |
$15K |
| 76870 |
|
211 |
186 |
$15K |
| 85610 |
|
9,627 |
7,246 |
$15K |
| 72050 |
|
701 |
635 |
$14K |
| 73562 |
|
1,431 |
1,024 |
$14K |
| 73610 |
|
3,754 |
3,084 |
$13K |
| 29125 |
|
112 |
105 |
$12K |
| 81001 |
|
48,100 |
39,926 |
$12K |
| 12011 |
|
75 |
66 |
$12K |
| 72100 |
|
952 |
856 |
$12K |
| 94799 |
|
4,135 |
1,898 |
$12K |
| 92610 |
|
153 |
131 |
$11K |
| 74174 |
|
120 |
104 |
$11K |
| J2405 |
Ondansetron hcl injection |
35,021 |
27,111 |
$11K |
| 74018 |
|
1,537 |
1,206 |
$11K |
| 73221 |
|
63 |
55 |
$11K |
| 36415 |
|
10,872 |
8,999 |
$10K |
| 84702 |
|
6,480 |
5,165 |
$10K |
| 94660 |
|
46 |
24 |
$10K |
| 81003 |
|
18,929 |
16,184 |
$10K |
| 87086 |
|
18,411 |
15,495 |
$9K |
| 86850 |
|
4,220 |
3,661 |
$9K |
| 87491 |
|
14,113 |
12,455 |
$9K |
| 81025 |
|
21,116 |
18,357 |
$9K |
| 97014 |
|
453 |
126 |
$9K |
| 83605 |
|
10,073 |
7,884 |
$9K |
| 86923 |
|
411 |
310 |
$9K |
| 93880 |
|
109 |
96 |
$8K |
| 83036 |
|
3,073 |
2,687 |
$8K |
| 85014 |
|
11,980 |
9,925 |
$8K |
| 80061 |
|
2,401 |
2,055 |
$7K |
| 97163 |
|
165 |
138 |
$7K |
| 90471 |
|
2,660 |
2,278 |
$7K |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
30,356 |
24,176 |
$7K |
| 85018 |
|
2,888 |
2,171 |
$7K |
| 84443 |
|
4,711 |
4,089 |
$7K |
| 73110 |
|
1,667 |
1,393 |
$6K |
| 82306 |
|
605 |
526 |
$6K |
| 82565 |
|
4,524 |
3,756 |
$6K |
| 83735 |
|
9,165 |
6,836 |
$6K |
| 80320 |
|
1,525 |
1,280 |
$6K |
| J1885 |
Ketorolac tromethamine inj |
21,790 |
18,172 |
$6K |
| 73700 |
|
70 |
63 |
$6K |
| 70544 |
|
17 |
15 |
$6K |
| 99234 |
|
611 |
542 |
$6K |
| 83690 |
|
25,629 |
20,835 |
$5K |
| G0151 |
Hhcp-serv of pt,ea 15 min |
140 |
55 |
$5K |
| 86900 |
|
6,335 |
5,157 |
$5K |
| 93350 |
|
33 |
26 |
$5K |
| J2270 |
Morphine sulfate injection |
14,284 |
10,134 |
$5K |
| 80143 |
|
1,021 |
932 |
$5K |
| J1644 |
Inj heparin sodium per 1000u |
11,964 |
4,341 |
$5K |
| 87077 |
|
7,429 |
6,209 |
$5K |
| 82553 |
|
1,328 |
849 |
$4K |
| J1170 |
Hydromorphone injection |
11,963 |
7,128 |
$4K |
| 87070 |
|
1,519 |
1,291 |
$4K |
| 84100 |
|
2,937 |
2,129 |
$4K |
| G0152 |
Hhcp-serv of ot,ea 15 min |
159 |
48 |
$4K |
| 20610 |
|
147 |
94 |
$4K |
| 36000 |
|
53 |
52 |
$4K |
| 87186 |
|
5,118 |
4,192 |
$4K |
| 96367 |
|
412 |
341 |
$4K |
| 86901 |
|
6,333 |
5,158 |
$4K |
| G0257 |
Unsched dialysis esrd pt hos |
180 |
62 |
$4K |
| 73080 |
|
887 |
770 |
$3K |
| J1100 |
Dexamethasone sodium phos |
9,810 |
8,625 |
$3K |
| 87880 |
|
4,487 |
4,038 |
$3K |
| 73140 |
|
956 |
859 |
$3K |
| 93296 |
|
544 |
410 |
$3K |
| 82077 |
|
8,146 |
6,793 |
$3K |
| M0243 |
Casirivi and imdevi inj |
16 |
16 |
$3K |
| J2930 |
Methylprednisolone injection |
2,173 |
1,736 |
$3K |
| 43235 |
|
16 |
13 |
$3K |
| 77062 |
|
79 |
71 |
$3K |
| 85730 |
|
4,655 |
3,800 |
$3K |
| 73590 |
|
969 |
796 |
$3K |
| 87210 |
|
11,646 |
10,217 |
$3K |
| 97542 |
|
105 |
69 |
$2K |
| 72131 |
|
54 |
44 |
$2K |
| 72158 |
|
12 |
12 |
$2K |
| 97035 |
|
33 |
12 |
$2K |
| 84145 |
|
386 |
336 |
$2K |
| Q0162 |
Ondansetron oral |
6,982 |
5,956 |
$2K |
| 80179 |
|
936 |
872 |
$2K |
| J2765 |
Metoclopramide hcl injection |
3,034 |
2,433 |
$2K |
| J2060 |
Lorazepam injection |
4,339 |
3,291 |
$2K |
| 92526 |
|
83 |
36 |
$2K |
| 94618 |
|
28 |
26 |
$2K |
| 90686 |
|
147 |
130 |
$2K |
| 77061 |
|
69 |
50 |
$2K |
| 76882 |
|
19 |
14 |
$2K |
| J1650 |
Inj enoxaparin sodium |
1,140 |
535 |
$2K |
| 82607 |
|
467 |
412 |
$2K |
| 82550 |
|
1,945 |
1,577 |
$2K |
| 11721 |
|
273 |
151 |
$2K |
| J0696 |
Ceftriaxone sodium injection |
9,708 |
7,491 |
$1K |
| J2550 |
Promethazine hcl injection |
4,257 |
3,176 |
$1K |
| J2250 |
Inj midazolam hydrochloride |
9,299 |
8,321 |
$1K |
| 0225U |
|
18 |
12 |
$1K |
| 97032 |
|
24 |
12 |
$1K |
| 87633 |
|
12 |
12 |
$1K |
| J7613 |
Albuterol non-comp unit |
4,171 |
3,237 |
$1K |
| 72040 |
|
56 |
52 |
$1K |
| 87081 |
|
3,249 |
3,000 |
$1K |
| J1200 |
Diphenhydramine hcl injectio |
7,000 |
5,297 |
$1K |
| J8597 |
Antiemetic drug oral nos |
925 |
733 |
$1K |
| 87804 |
|
1,869 |
1,076 |
$1K |
| 85652 |
|
1,028 |
873 |
$997.35 |
| 51798 |
|
144 |
97 |
$956.07 |
| 82803 |
|
1,927 |
1,543 |
$938.28 |
| A9500 |
Tc99m sestamibi |
1,348 |
1,173 |
$854.73 |
| C1769 |
Guide wire |
1,198 |
1,002 |
$848.52 |
| 73560 |
|
94 |
62 |
$821.37 |
| 72072 |
|
56 |
49 |
$814.98 |
| 87631 |
|
37 |
33 |
$635.33 |
| 85384 |
|
599 |
501 |
$618.86 |
| 87205 |
|
1,557 |
1,270 |
$615.90 |
| 90656 |
|
32 |
31 |
$601.25 |
| 73552 |
|
136 |
107 |
$594.54 |
| 96368 |
|
41 |
39 |
$565.06 |
| J7644 |
Ipratropium bromide non-comp |
608 |
508 |
$556.25 |
| 87634 |
|
28 |
27 |
$542.68 |
| J2704 |
Inj, propofol, 10 mg |
10,897 |
9,795 |
$540.94 |
| 84439 |
|
154 |
141 |
$540.26 |
| J1630 |
Haloperidol injection |
5,551 |
4,599 |
$535.64 |
| 36600 |
|
256 |
214 |
$533.67 |
| Q9969 |
Non-heu tc-99m add-on/dose |
1,552 |
1,355 |
$527.99 |
| 83615 |
|
1,116 |
922 |
$504.23 |
| 87637 |
|
1,199 |
1,131 |
$490.71 |
| 71101 |
|
110 |
93 |
$480.31 |
| 82310 |
|
4,119 |
3,619 |
$473.12 |
| 74022 |
|
117 |
88 |
$434.77 |
| 82570 |
|
823 |
695 |
$412.52 |
| 80069 |
|
63 |
49 |
$411.28 |
| 80164 |
|
75 |
63 |
$410.55 |
| J3480 |
Inj potassium chloride |
698 |
475 |
$400.26 |
| J0690 |
Cefazolin sodium injection |
6,766 |
4,734 |
$384.23 |
| 86140 |
|
247 |
213 |
$362.79 |
| 0115U |
|
13 |
12 |
$361.34 |
| M0222 |
Bebtelovimab injection |
28 |
24 |
$350.50 |
| 94010 |
|
15 |
15 |
$346.48 |
| A9575 |
Inj gadoterate meglumi 0.1ml |
3,000 |
2,266 |
$281.24 |
| 88342 |
|
653 |
554 |
$278.22 |
| 83970 |
|
36 |
26 |
$275.69 |
| J2785 |
Regadenoson injection |
1,019 |
889 |
$257.89 |
| J3370 |
Vancomycin hcl injection |
1,772 |
744 |
$257.02 |
| 73660 |
|
82 |
69 |
$255.90 |
| 82746 |
|
104 |
98 |
$255.90 |
| 84520 |
|
717 |
567 |
$241.40 |
| 84550 |
|
988 |
821 |
$233.49 |
| 92611 |
|
16 |
12 |
$231.59 |
| 74230 |
|
16 |
12 |
$203.92 |
| 80329 |
|
18 |
13 |
$201.92 |
| 84156 |
|
644 |
524 |
$190.30 |
| 82140 |
|
192 |
145 |
$176.20 |
| 72170 |
|
29 |
26 |
$164.44 |
| 82728 |
|
50 |
44 |
$162.75 |
| 83550 |
|
170 |
155 |
$162.72 |
| J0780 |
Prochlorperazine injection |
2,655 |
2,223 |
$161.43 |
| 83540 |
|
207 |
185 |
$150.91 |
| U0005 |
Infec agen detec ampli probe |
261 |
253 |
$150.54 |
| 73090 |
|
243 |
205 |
$143.62 |
| 82272 |
|
1,278 |
1,057 |
$141.98 |
| 82330 |
|
400 |
329 |
$132.76 |
| 70355 |
|
17 |
13 |
$127.66 |
| J1940 |
Furosemide injection |
1,795 |
1,057 |
$112.65 |
| 88304 |
|
836 |
761 |
$109.19 |
| 88302 |
|
72 |
61 |
$93.36 |
| 84132 |
|
489 |
367 |
$79.87 |
| 87340 |
|
164 |
143 |
$61.88 |
| G0008 |
Admin influenza virus vac |
176 |
143 |
$46.16 |
| 85045 |
|
354 |
225 |
$45.23 |
| 84450 |
|
277 |
223 |
$44.24 |
| 84460 |
|
232 |
195 |
$29.60 |
| J3535 |
Metered dose inhaler drug |
15 |
12 |
$29.42 |
| J1815 |
Insulin injection |
211 |
109 |
$29.22 |
| J0171 |
Adrenalin epinephrine inject |
509 |
429 |
$25.72 |
| J2272 |
Inj, morphine (fresenius) |
1,280 |
963 |
$24.68 |
| A6457 |
Tubular dressing |
1,473 |
574 |
$19.39 |
| J1953 |
Levetiracetam injection |
552 |
382 |
$17.50 |
| J7611 |
Albuterol non-comp con |
133 |
120 |
$15.33 |
| J0360 |
Hydralazine hcl injection |
641 |
453 |
$14.83 |
| Q0177 |
Hydroxyzine pamoate 25mg |
969 |
646 |
$14.52 |
| Q0169 |
Promethazine hcl 12.5mg oral |
99 |
73 |
$12.91 |
| 85046 |
|
480 |
298 |
$12.78 |
| A6197 |
Alginate drsg >16 <=48 sq in |
459 |
323 |
$11.89 |
| A9552 |
F18 fdg |
1,801 |
1,642 |
$7.25 |
| 82009 |
|
450 |
412 |
$5.36 |
| P9603 |
One-way allow prorated miles |
109 |
84 |
$4.25 |
| J3360 |
Diazepam injection |
198 |
149 |
$4.12 |
| J7620 |
Albuterol ipratrop non-comp |
957 |
644 |
$3.07 |
| 90756 |
|
23 |
16 |
$2.47 |
| J2919 |
Inj, methylpred sod succ 5mg |
402 |
219 |
$2.39 |
| J1642 |
Inj heparin sodium per 10 u |
17 |
12 |
$1.75 |
| J3301 |
Triamcinolone acet inj nos |
439 |
296 |
$1.63 |
| J7512 |
Prednisone ir or dr oral 1mg |
481 |
412 |
$1.06 |
| A9585 |
Gadobutrol injection |
714 |
455 |
$1.00 |
| J1171 |
Inj, hydromorphone, 0.1 mg |
599 |
320 |
$0.99 |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
922 |
378 |
$0.97 |
| J7030 |
Normal saline solution infus |
20 |
12 |
$0.66 |
| J0665 |
Inj, bupivacaine, nos, 0.5mg |
299 |
281 |
$0.66 |
| J1817 |
Insulin for insulin pump use |
418 |
171 |
$0.06 |
| G8978 |
Mobility current status |
376 |
231 |
$0.01 |
| G8979 |
Mobility goal status |
431 |
263 |
$0.01 |
| G1004 |
Cdsm ndsc |
692 |
570 |
$0.00 |
| J1596 |
Inj, glycopyrrolate, 0.1 mg |
213 |
201 |
$0.00 |
| J3475 |
Inj magnesium sulfate |
287 |
238 |
$0.00 |
| 51702 |
|
29 |
25 |
$0.00 |
| C1760 |
Closure dev, vasc |
210 |
162 |
$0.00 |
| C1782 |
Morcellator |
17 |
13 |
$0.00 |
| C1894 |
Intro/sheath, non-laser |
361 |
306 |
$0.00 |
| Q9957 |
Inj perflutren lip micros,ml |
351 |
323 |
$0.00 |
| C1887 |
Catheter, guiding |
14 |
12 |
$0.00 |
| J0692 |
Cefepime hcl for injection |
122 |
45 |
$0.00 |
| A6198 |
Alginate dressing > 48 sq in |
117 |
75 |
$0.00 |
| 76376 |
|
15 |
12 |
$0.00 |
| 87075 |
|
84 |
70 |
$0.00 |
| A6212 |
Foam drg <=16 sq in w/border |
86 |
52 |
$0.00 |
| J0688 |
Inj cefazolin sodium, hikma |
25 |
16 |
$0.00 |
| A6253 |
Absorpt drg > 48 sq in w/o b |
34 |
15 |
$0.00 |
| J0736 |
Inj, clindamycin phosp 300mg |
56 |
40 |
$0.00 |
| Q0243 |
Casirivimab and imdevimab |
12 |
12 |
$0.00 |
| J2310 |
Inj naloxone hydrochloride |
17 |
13 |
$0.00 |
| 80202 |
|
25 |
15 |
$0.00 |
| L3908 |
Who cock-up nonmolde pre ots |
14 |
12 |
$0.00 |
| 87899 |
|
16 |
14 |
$0.00 |
| 87076 |
|
15 |
12 |
$0.00 |
| A6213 |
Foam drg >16<=48 sq in w/bdr |
707 |
412 |
$0.00 |
| J2543 |
Piperacillin/tazobactam |
3,081 |
829 |
$0.00 |
| 87493 |
|
19 |
14 |
$0.00 |
| A4648 |
Implantable tissue marker |
63 |
56 |
$0.00 |
| A6022 |
Collagen drsg>16<=48 sq in |
66 |
48 |
$0.00 |
| J0456 |
Azithromycin |
95 |
53 |
$0.00 |
| A6214 |
Foam drg > 48 sq in w/border |
57 |
39 |
$0.00 |
| A6449 |
Lt compres band >=3" <5"/yd |
761 |
234 |
$0.00 |
| 87426 |
|
60 |
52 |
$0.00 |
| 88341 |
|
145 |
109 |
$0.00 |
| J0280 |
Aminophyllin 250 mg inj |
173 |
163 |
$0.00 |
| 36416 |
|
92 |
40 |
$0.00 |
| A9503 |
Tc99m medronate |
16 |
12 |
$0.00 |
| 87449 |
|
66 |
53 |
$0.00 |
| A6222 |
Gauze <=16 in no w/sal w/o b |
41 |
29 |
$0.00 |
| 73060 |
|
28 |
25 |
$0.00 |
| J2920 |
Methylprednisolone injection |
31 |
15 |
$0.00 |
| A6441 |
Pad band w>=3" <5"/yd |
25 |
12 |
$0.00 |
| A6454 |
Self-adher band w>=3" <5"/yd |
26 |
13 |
$0.00 |
| C1781 |
Mesh (implantable) |
13 |
12 |
$0.00 |