| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
|
600 |
534 |
$37K |
| 99213 |
|
658 |
454 |
$28K |
| 96365 |
|
332 |
167 |
$17K |
| 96375 |
|
293 |
143 |
$15K |
| 99442 |
|
203 |
175 |
$9K |
| 99051 |
|
373 |
309 |
$8K |
| 99204 |
|
83 |
81 |
$7K |
| 83880 |
|
224 |
177 |
$5K |
| 82306 |
|
225 |
219 |
$4K |
| J3490 |
Drugs unclassified injection |
567 |
142 |
$4K |
| 80305 |
|
386 |
380 |
$4K |
| 80053 |
|
408 |
283 |
$3K |
| 84443 |
|
229 |
220 |
$2K |
| 82784 |
|
129 |
123 |
$2K |
| 82607 |
|
217 |
211 |
$2K |
| 82746 |
|
216 |
210 |
$2K |
| 85025 |
|
374 |
281 |
$2K |
| 82728 |
|
210 |
203 |
$2K |
| 36415 |
|
563 |
409 |
$2K |
| 96361 |
|
115 |
63 |
$2K |
| 96372 |
|
106 |
83 |
$2K |
| 99203 |
|
32 |
32 |
$2K |
| 80061 |
|
192 |
185 |
$2K |
| 99441 |
|
59 |
59 |
$2K |
| 83735 |
|
335 |
235 |
$2K |
| 87811 |
|
39 |
37 |
$1K |
| 83550 |
|
226 |
219 |
$1K |
| 83036 |
|
231 |
223 |
$1K |
| 83540 |
|
226 |
219 |
$974.96 |
| 87804 |
|
81 |
37 |
$894.73 |
| J1885 |
Ketorolac tromethamine inj |
326 |
165 |
$825.73 |
| 82552 |
|
92 |
80 |
$761.58 |
| 84436 |
|
213 |
205 |
$674.51 |
| 83874 |
|
91 |
79 |
$671.22 |
| J2300 |
Inj nalbuphine hydrochloride |
206 |
92 |
$551.38 |
| 99050 |
|
28 |
24 |
$484.41 |
| 85049 |
|
164 |
106 |
$466.93 |
| 80051 |
|
126 |
98 |
$443.80 |
| 84484 |
|
92 |
80 |
$418.50 |
| J7040 |
Normal saline solution infus |
170 |
92 |
$415.71 |
| J3420 |
Vitamin b12 injection |
301 |
158 |
$390.50 |
| 82550 |
|
92 |
80 |
$380.22 |
| 93000 |
|
32 |
30 |
$379.86 |
| 84460 |
|
140 |
107 |
$356.19 |
| 84075 |
|
141 |
108 |
$348.50 |
| 84450 |
|
140 |
107 |
$347.85 |
| 82310 |
|
139 |
107 |
$342.05 |
| 87880 |
|
31 |
31 |
$337.28 |
| 82565 |
|
139 |
108 |
$335.45 |
| 82247 |
|
139 |
107 |
$333.47 |
| 82040 |
|
140 |
107 |
$332.22 |
| J3475 |
Inj magnesium sulfate |
227 |
112 |
$325.08 |
| 99401 |
|
12 |
12 |
$312.53 |
| 83690 |
|
104 |
98 |
$296.57 |
| J1100 |
Dexamethasone sodium phos |
188 |
111 |
$269.64 |
| 84520 |
|
138 |
107 |
$255.65 |
| 85018 |
|
163 |
105 |
$246.38 |
| 84155 |
|
140 |
107 |
$246.21 |
| 85014 |
|
163 |
105 |
$244.51 |
| 94640 |
|
26 |
12 |
$217.55 |
| 85041 |
|
114 |
87 |
$201.84 |
| J0696 |
Ceftriaxone sodium injection |
55 |
32 |
$175.97 |
| 85048 |
|
104 |
79 |
$149.96 |
| 82553 |
|
87 |
77 |
$145.44 |
| J1200 |
Diphenhydramine hcl injectio |
149 |
66 |
$121.84 |
| J2405 |
Ondansetron hcl injection |
254 |
133 |
$91.66 |
| 82150 |
|
105 |
99 |
$90.36 |
| J1940 |
Furosemide injection |
73 |
25 |
$86.95 |
| 81003 |
|
43 |
41 |
$70.48 |
| J7050 |
Normal saline solution infus |
92 |
66 |
$24.00 |
| 99408 |
|
12 |
12 |
$15.00 |
| J7030 |
Normal saline solution infus |
24 |
13 |
$8.74 |
| J7614 |
Levalbuterol non-comp unit |
23 |
12 |
$2.99 |