| Code | Description | Claims | Beneficiaries | Total Paid |
| 0450 |
|
16,999 |
14,972 |
$251K |
| 99281 |
|
10,264 |
8,845 |
$236K |
| 87636 |
|
4,398 |
4,111 |
$111K |
| 70450 |
|
1,042 |
1,004 |
$85K |
| 74177 |
|
938 |
920 |
$85K |
| 96374 |
|
3,009 |
2,721 |
$50K |
| 85025 |
|
12,631 |
11,343 |
$42K |
| 80051 |
|
13,206 |
11,596 |
$40K |
| 96375 |
|
2,182 |
1,974 |
$31K |
| 82565 |
|
13,603 |
12,031 |
$30K |
| 84702 |
|
3,546 |
3,236 |
$23K |
| 84520 |
|
12,535 |
11,103 |
$20K |
| 80307 |
|
1,161 |
1,009 |
$20K |
| 84484 |
|
4,130 |
3,376 |
$20K |
| 82947 |
|
12,047 |
10,882 |
$19K |
| 87591 |
|
1,186 |
1,113 |
$19K |
| 87491 |
|
1,174 |
1,101 |
$18K |
| 96365 |
|
808 |
750 |
$16K |
| 76830 |
|
506 |
478 |
$16K |
| 76856 |
|
529 |
501 |
$16K |
| 84460 |
|
6,524 |
6,024 |
$15K |
| J7030 |
Normal saline solution infus |
4,968 |
4,306 |
$15K |
| U0003 |
Cov-19 amp prb hgh thruput |
341 |
321 |
$15K |
| 83690 |
|
4,739 |
4,421 |
$13K |
| 82247 |
|
6,063 |
5,521 |
$13K |
| 84450 |
|
5,706 |
5,261 |
$13K |
| 84075 |
|
5,580 |
5,155 |
$12K |
| 71045 |
|
2,674 |
2,529 |
$12K |
| 93005 |
|
784 |
754 |
$12K |
| 83880 |
|
1,228 |
1,141 |
$11K |
| J0131 |
Inj, acetaminophen (nos) |
597 |
569 |
$10K |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
2,102 |
1,989 |
$9K |
| 0111 |
|
16 |
14 |
$9K |
| 74176 |
|
154 |
151 |
$8K |
| 87088 |
|
2,493 |
2,398 |
$8K |
| 71046 |
|
925 |
899 |
$8K |
| 85027 |
|
1,826 |
1,727 |
$6K |
| 81003 |
|
7,080 |
6,664 |
$6K |
| 96372 |
|
1,198 |
1,132 |
$5K |
| 85610 |
|
3,077 |
2,854 |
$5K |
| 82248 |
|
2,690 |
2,523 |
$5K |
| 76705 |
|
219 |
215 |
$5K |
| 82310 |
|
2,363 |
2,195 |
$5K |
| J1885 |
Ketorolac tromethamine inj |
2,761 |
2,358 |
$5K |
| 96361 |
|
503 |
482 |
$5K |
| 87040 |
|
1,456 |
728 |
$5K |
| J2405 |
Ondansetron hcl injection |
2,541 |
2,305 |
$5K |
| 90686 |
|
846 |
829 |
$4K |
| 83605 |
|
1,113 |
906 |
$4K |
| 82077 |
|
1,128 |
1,001 |
$4K |
| J2270 |
Morphine sulfate injection |
1,231 |
1,067 |
$4K |
| 83735 |
|
1,176 |
1,014 |
$3K |
| J0696 |
Ceftriaxone sodium injection |
1,268 |
1,190 |
$3K |
| 80306 |
|
442 |
415 |
$3K |
| 84443 |
|
254 |
247 |
$3K |
| 83036 |
|
437 |
430 |
$3K |
| 87502 |
|
92 |
91 |
$3K |
| 86901 |
|
1,238 |
1,130 |
$2K |
| 87635 |
|
46 |
43 |
$2K |
| 86900 |
|
1,232 |
1,124 |
$1K |
| 80179 |
|
369 |
343 |
$1K |
| 87389 |
|
170 |
168 |
$1K |
| 86780 |
|
246 |
232 |
$1K |
| 86885 |
|
557 |
541 |
$1K |
| 99291 |
|
60 |
58 |
$1K |
| 73610 |
|
62 |
51 |
$843.92 |
| 71275 |
|
13 |
13 |
$769.40 |
| 85379 |
|
191 |
183 |
$760.01 |
| 80061 |
|
76 |
75 |
$716.56 |
| 86141 |
|
281 |
270 |
$690.51 |
| 76805 |
|
12 |
12 |
$642.96 |
| 87210 |
|
226 |
213 |
$608.22 |
| J0134 |
Inj acetaminophen -fresenius |
117 |
115 |
$522.98 |
| 73562 |
|
37 |
36 |
$455.82 |
| 99283 |
|
234 |
222 |
$444.59 |
| 86803 |
|
44 |
44 |
$439.22 |
| J2060 |
Lorazepam injection |
175 |
149 |
$365.52 |
| J3490 |
Drugs unclassified injection |
1,220 |
1,007 |
$358.31 |
| 0301 |
|
657 |
524 |
$303.32 |
| 87637 |
|
37 |
36 |
$285.26 |
| 87340 |
|
28 |
28 |
$237.93 |
| 73030 |
|
13 |
12 |
$224.48 |
| 87186 |
|
54 |
54 |
$216.03 |
| 84100 |
|
125 |
93 |
$197.55 |
| 90688 |
|
15 |
15 |
$189.04 |
| 86762 |
|
13 |
12 |
$171.14 |
| J2765 |
Metoclopramide hcl injection |
108 |
101 |
$154.62 |
| 0637 |
|
11,709 |
7,243 |
$152.10 |
| 73630 |
|
15 |
12 |
$151.83 |
| 86787 |
|
12 |
12 |
$149.74 |
| 85730 |
|
64 |
53 |
$144.96 |
| 96360 |
|
12 |
12 |
$127.42 |
| 90674 |
|
36 |
35 |
$123.04 |
| 90656 |
|
43 |
43 |
$122.74 |
| 73130 |
|
12 |
12 |
$118.28 |
| J1200 |
Diphenhydramine hcl injectio |
87 |
78 |
$106.74 |
| 87804 |
|
60 |
42 |
$106.20 |
| 0710 |
|
14 |
13 |
$103.74 |
| 0250 |
|
2,900 |
2,364 |
$100.09 |
| J1100 |
Dexamethasone sodium phos |
101 |
83 |
$97.56 |
| J7120 |
Ringers lactate infusion |
18 |
16 |
$94.40 |
| 85652 |
|
111 |
109 |
$75.15 |
| 87081 |
|
56 |
56 |
$67.36 |
| 82962 |
|
196 |
157 |
$39.82 |
| J1815 |
Insulin injection |
18 |
12 |
$39.46 |
| 80320 |
|
172 |
146 |
$37.20 |
| 82040 |
|
12 |
12 |
$29.50 |
| J2001 |
Lidocaine injection |
12 |
12 |
$24.53 |
| 0258 |
|
1,790 |
1,550 |
$18.05 |
| Q0144 |
Azithromycin dihydrate, oral |
13 |
13 |
$13.59 |
| S0119 |
Ondansetron 4 mg |
98 |
95 |
$1.39 |
| 0302 |
|
434 |
367 |
$0.00 |
| 0320 |
|
122 |
107 |
$0.00 |
| 0260 |
|
121 |
98 |
$0.00 |
| 0300 |
|
147 |
123 |
$0.00 |
| J3475 |
Inj magnesium sulfate |
14 |
13 |
$0.00 |
| 80324 |
|
149 |
140 |
$0.00 |
| G0008 |
Admin influenza virus vac |
68 |
67 |
$0.00 |
| 0307 |
|
50 |
44 |
$0.00 |
| 0306 |
|
196 |
166 |
$0.00 |
| 80359 |
|
149 |
140 |
$0.00 |
| 0305 |
|
660 |
542 |
$0.00 |
| G0378 |
Hospital observation per hr |
26 |
12 |
$0.00 |
| 99251 |
|
33 |
32 |
$0.00 |
| J3480 |
Inj potassium chloride |
16 |
14 |
$0.00 |
| 0112 |
|
28 |
27 |
$0.00 |
| 80329 |
|
29 |
15 |
$0.00 |
| 0255 |
|
16 |
12 |
$0.00 |
| 99282 |
|
14 |
14 |
$0.00 |
| 0370 |
|
15 |
14 |
$0.00 |