| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99283 |
|
895 |
765 |
$72K |
| 99284 |
|
503 |
408 |
$45K |
| 96361 |
|
201 |
153 |
$44K |
| 99214 |
|
365 |
358 |
$19K |
| 99213 |
|
304 |
288 |
$16K |
| 97110 |
|
244 |
89 |
$8K |
| 64415 |
|
43 |
39 |
$6K |
| 87636 |
|
170 |
168 |
$6K |
| 0241U |
|
51 |
35 |
$6K |
| 99211 |
|
87 |
79 |
$5K |
| 80053 |
|
721 |
583 |
$4K |
| 64483 |
|
12 |
12 |
$2K |
| 93005 |
|
184 |
152 |
$2K |
| 87637 |
|
89 |
75 |
$2K |
| 85025 |
|
844 |
662 |
$2K |
| 85610 |
|
189 |
167 |
$1K |
| 81001 |
|
440 |
364 |
$698.12 |
| 85730 |
|
171 |
151 |
$682.95 |
| G0463 |
Hospital outpt clinic visit |
39 |
38 |
$650.39 |
| 80048 |
|
204 |
134 |
$525.67 |
| 73130 |
|
46 |
39 |
$500.75 |
| J3490 |
Drugs unclassified injection |
244 |
141 |
$414.63 |
| 71046 |
|
119 |
92 |
$392.52 |
| 87641 |
|
13 |
12 |
$357.49 |
| 73110 |
|
16 |
16 |
$224.90 |
| 36415 |
|
1,009 |
757 |
$223.82 |
| 87086 |
|
43 |
40 |
$144.54 |
| J8499 |
Oral prescrip drug non chemo |
76 |
44 |
$100.34 |
| 72100 |
|
209 |
174 |
$75.02 |
| 82947 |
|
67 |
28 |
$67.26 |
| 96375 |
|
182 |
132 |
$55.51 |
| J0689 |
Inj cefazolin sodium, baxter |
535 |
415 |
$49.68 |
| J7120 |
Ringers lactate infusion |
1,848 |
1,332 |
$47.80 |
| J1170 |
Hydromorphone injection |
93 |
61 |
$43.73 |
| 96374 |
|
311 |
238 |
$27.75 |
| 81025 |
|
531 |
421 |
$25.65 |
| J1885 |
Ketorolac tromethamine inj |
959 |
703 |
$22.69 |
| J3010 |
Fentanyl citrate injection |
1,453 |
918 |
$21.01 |
| J2704 |
Inj, propofol, 10 mg |
1,443 |
1,080 |
$19.50 |
| J7030 |
Normal saline solution infus |
191 |
134 |
$15.59 |
| J1100 |
Dexamethasone sodium phos |
1,143 |
735 |
$12.00 |
| 81003 |
|
43 |
40 |
$8.93 |
| J2405 |
Ondansetron hcl injection |
1,195 |
899 |
$8.00 |
| J2250 |
Inj midazolam hydrochloride |
1,218 |
943 |
$3.83 |
| J2003 |
Inj, lidocaine hcl, 1 mg |
168 |
152 |
$3.33 |
| J2795 |
Ropivacaine hcl injection |
132 |
104 |
$0.00 |
| 96372 |
|
137 |
115 |
$0.00 |
| 94760 |
|
19 |
13 |
$0.00 |
| 84484 |
|
45 |
27 |
$0.00 |
| J0690 |
Cefazolin sodium injection |
468 |
275 |
$0.00 |
| J7999 |
Compounded drug, noc |
63 |
52 |
$0.00 |
| J0696 |
Ceftriaxone sodium injection |
12 |
12 |
$0.00 |
| 87651 |
|
25 |
20 |
$0.00 |
| J1010 |
Inj, methylpred acetate 1 mg |
12 |
12 |
$0.00 |
| 85027 |
|
17 |
13 |
$0.00 |
| Q9966 |
Locm 200-299mg/ml iodine,1ml |
90 |
89 |
$0.00 |
| C1713 |
Anchor/screw bn/bn,tis/bn |
261 |
196 |
$0.00 |
| J3301 |
Triamcinolone acet inj nos |
497 |
427 |
$0.00 |
| J0665 |
Inj, bupivacaine, nos, 0.5mg |
168 |
141 |
$0.00 |
| A4649 |
Surgical supplies |
109 |
92 |
$0.00 |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
36 |
28 |
$0.00 |