| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J9271 |
Inj pembrolizumab |
6,182 |
4,491 |
$33.02M |
| 99212 |
|
123,385 |
80,896 |
$25.44M |
| 96413 |
|
75,242 |
41,464 |
$13.14M |
| J2506 |
Inj pegfilgrast ex bio 0.5mg |
5,051 |
3,462 |
$11.11M |
| J9299 |
Injection, nivolumab |
2,754 |
1,817 |
$10.92M |
| J9035 |
Bevacizumab injection |
6,685 |
2,750 |
$8.80M |
| J2505 |
Injection, pegfilgrastim 6mg |
3,900 |
2,804 |
$8.66M |
| 96361 |
|
21,276 |
13,046 |
$7.13M |
| J9355 |
Inj trastuzumab excl biosimi |
3,381 |
2,351 |
$5.06M |
| G0463 |
Hospital outpt clinic visit |
149,281 |
102,728 |
$4.62M |
| 96415 |
|
14,913 |
9,021 |
$4.43M |
| J9306 |
Injection, pertuzumab, 1 mg |
1,706 |
1,207 |
$4.30M |
| 96375 |
|
50,625 |
27,935 |
$4.05M |
| J9144 |
Daratumumab, hyaluronidase |
1,656 |
1,024 |
$4.04M |
| 80053 |
|
190,810 |
121,680 |
$4.00M |
| 36430 |
|
10,799 |
6,522 |
$3.69M |
| 78815 |
|
3,602 |
3,371 |
$3.44M |
| J9358 |
Inj fam-trastu deru-nxki 1mg |
1,252 |
630 |
$3.43M |
| 99214 |
|
22,267 |
18,849 |
$3.17M |
| 96365 |
|
19,265 |
14,947 |
$3.00M |
| J2796 |
Romiplostim injection |
3,634 |
1,144 |
$2.91M |
| J0185 |
Inj., aprepitant, 1 mg |
12,866 |
8,090 |
$2.79M |
| 74177 |
|
11,796 |
11,322 |
$2.58M |
| J9217 |
Leuprolide acetate suspnsion |
4,772 |
4,501 |
$2.30M |
| J9041 |
Injection, bortezomib, 0.1mg |
5,655 |
1,362 |
$2.19M |
| 96372 |
|
27,641 |
18,996 |
$2.18M |
| 99215 |
Prolong outpt/office vis |
9,620 |
8,182 |
$2.17M |
| 96360 |
|
12,847 |
7,553 |
$1.95M |
| 99203 |
|
11,466 |
9,827 |
$1.83M |
| J1561 |
Gamunex-c/gammaked |
3,086 |
1,674 |
$1.80M |
| J2469 |
Palonosetron hcl |
19,705 |
11,507 |
$1.76M |
| Q0138 |
Ferumoxytol, non-esrd |
5,500 |
3,744 |
$1.70M |
| 71260 |
|
13,698 |
13,106 |
$1.67M |
| J0897 |
Denosumab injection |
2,559 |
2,312 |
$1.55M |
| 96367 |
|
14,148 |
9,361 |
$1.54M |
| 96401 |
|
9,809 |
4,584 |
$1.50M |
| J1950 |
Leuprolide acetate /3.75 mg |
1,279 |
1,197 |
$1.46M |
| J9395 |
Injection, fulvestrant |
2,254 |
1,865 |
$1.41M |
| 70553 |
|
3,501 |
3,288 |
$1.41M |
| 85025 |
|
197,766 |
130,093 |
$1.39M |
| 99213 |
|
9,953 |
8,618 |
$1.33M |
| J9305 |
Inj. pemetrexed nos 10mg |
783 |
519 |
$1.23M |
| 96409 |
|
13,502 |
7,526 |
$1.16M |
| 96366 |
|
4,888 |
3,876 |
$1.15M |
| 77386 |
|
4,867 |
467 |
$1.05M |
| J9263 |
Oxaliplatin |
5,806 |
3,375 |
$1.03M |
| 96416 |
|
4,829 |
2,986 |
$987K |
| 96411 |
|
16,429 |
10,648 |
$985K |
| 99205 |
Prolong outpt/office vis |
3,938 |
3,490 |
$954K |
| 77412 |
|
3,682 |
394 |
$950K |
| J9312 |
Inj., rituximab, 10 mg |
560 |
273 |
$852K |
| 96417 |
|
19,594 |
12,247 |
$851K |
| 80050 |
|
11,294 |
9,320 |
$830K |
| 38222 |
|
2,107 |
1,728 |
$741K |
| 88185 |
|
3,805 |
3,151 |
$738K |
| 96374 |
|
17,081 |
11,244 |
$710K |
| J9070 |
Cyclophosphamide 100 mg inj |
3,028 |
1,717 |
$652K |
| 83735 |
|
82,349 |
48,670 |
$630K |
| J2353 |
Octreotide injection, depot |
252 |
209 |
$563K |
| Q5107 |
Inj mvasi 10 mg |
242 |
104 |
$537K |
| Q2050 |
Doxorubicin inj 10mg |
294 |
265 |
$512K |
| 77067 |
|
11,329 |
11,131 |
$508K |
| J1453 |
Fosaprepitant injection |
1,498 |
963 |
$485K |
| 77063 |
|
8,026 |
7,896 |
$482K |
| J9201 |
In gemcitabine hcl nos 200mg |
4,195 |
2,109 |
$481K |
| J0881 |
Darbepoetin alfa, non-esrd |
2,280 |
1,405 |
$464K |
| J0885 |
Epoetin alfa, non-esrd |
2,641 |
1,168 |
$460K |
| 96402 |
|
10,255 |
9,260 |
$451K |
| P9040 |
Rbc leukoreduced irradiated |
7,460 |
5,188 |
$443K |
| 96368 |
|
9,396 |
5,723 |
$430K |
| 82378 |
|
25,047 |
17,833 |
$427K |
| J1756 |
Iron sucrose injection |
7,652 |
4,379 |
$411K |
| 99204 |
|
1,860 |
1,813 |
$337K |
| 77336 |
|
3,740 |
1,621 |
$335K |
| 86850 |
|
28,659 |
15,061 |
$315K |
| J9354 |
Inj, ado-trastuzumab emt 1mg |
181 |
75 |
$310K |
| J3490 |
Drugs unclassified injection |
15,622 |
8,376 |
$289K |
| J1750 |
Inj iron dextran |
1,968 |
1,323 |
$287K |
| ATP14 |
|
35,891 |
21,994 |
$282K |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
14,183 |
13,499 |
$278K |
| 82784 |
|
20,154 |
16,352 |
$273K |
| 96450 |
|
397 |
278 |
$267K |
| 82728 |
|
27,350 |
25,245 |
$258K |
| J9316 |
Pertuzu, trastuzu, 10 mg |
34 |
25 |
$250K |
| 31575 |
|
1,322 |
1,204 |
$238K |
| P9037 |
Plate pheres leukoredu irrad |
1,067 |
535 |
$236K |
| 87497 |
|
6,352 |
3,675 |
$231K |
| J9022 |
Inj, atezolizumab,10 mg |
36 |
25 |
$229K |
| J9206 |
Irinotecan injection |
5,148 |
2,642 |
$227K |
| J2997 |
Alteplase recombinant |
1,967 |
1,707 |
$210K |
| 86923 |
|
6,783 |
4,647 |
$204K |
| 86300 |
|
9,877 |
7,619 |
$194K |
| 86900 |
|
29,436 |
15,536 |
$193K |
| 99443 |
|
1,510 |
1,349 |
$191K |
| Q5117 |
Inj., kanjinti, 10 mg |
61 |
47 |
$188K |
| J0640 |
Leucovorin calcium injection |
10,852 |
6,125 |
$186K |
| 86901 |
|
28,897 |
15,200 |
$186K |
| 74183 |
|
818 |
783 |
$185K |
| 78816 |
|
258 |
235 |
$167K |
| 84100 |
|
46,585 |
28,530 |
$156K |
| 86304 |
|
9,166 |
6,654 |
$155K |
| 87799 |
|
2,424 |
1,043 |
$154K |
| 83615 |
|
42,578 |
29,290 |
$153K |
| J9310 |
Rituximab injection |
142 |
89 |
$150K |
| 85027 |
|
22,468 |
13,242 |
$147K |
| G0498 |
Chemo extend iv infus w/pump |
2,892 |
1,767 |
$143K |
| 80048 |
|
7,368 |
5,380 |
$136K |
| 86334 |
|
11,808 |
9,889 |
$136K |
| 96377 |
|
4,677 |
3,566 |
$134K |
| 88184 |
|
3,824 |
3,196 |
$134K |
| 84439 |
|
12,324 |
10,234 |
$130K |
| 83550 |
|
19,150 |
18,153 |
$128K |
| 82306 |
|
5,974 |
5,488 |
$127K |
| J9264 |
Paclitaxel protein bound |
184 |
61 |
$123K |
| 97803 |
|
1,307 |
979 |
$118K |
| 76642 |
|
1,326 |
1,234 |
$107K |
| 83540 |
|
22,539 |
21,251 |
$107K |
| J3489 |
Zoledronic acid 1mg |
4,908 |
4,573 |
$104K |
| 80076 |
|
5,442 |
4,145 |
$103K |
| A9585 |
Gadobutrol injection |
6,442 |
6,079 |
$100K |
| 78306 |
|
608 |
582 |
$100K |
| 99202 |
|
383 |
374 |
$91K |
| ATP15 |
|
11,765 |
7,631 |
$91K |
| 86301 |
|
5,804 |
3,732 |
$91K |
| 82248 |
|
22,530 |
12,663 |
$89K |
| A9552 |
F18 fdg |
3,575 |
3,322 |
$89K |
| 88305 |
|
2,887 |
2,468 |
$88K |
| 82607 |
|
8,676 |
8,327 |
$80K |
| 83521 |
|
6,249 |
4,966 |
$77K |
| 83520 |
|
11,100 |
4,986 |
$75K |
| 81162 |
|
56 |
55 |
$74K |
| Q5115 |
Inj truxima 10 mg |
27 |
12 |
$73K |
| 84443 |
|
12,680 |
10,675 |
$70K |
| 85007 |
|
18,756 |
10,546 |
$70K |
| 93005 |
|
5,005 |
3,952 |
$68K |
| 71250 |
|
1,440 |
1,377 |
$65K |
| 84702 |
|
3,419 |
2,629 |
$62K |
| 88237 |
|
1,025 |
877 |
$61K |
| 84153 |
|
8,323 |
7,452 |
$61K |
| 84165 |
|
12,747 |
10,709 |
$60K |
| 88342 |
|
1,547 |
1,355 |
$59K |
| J9171 |
Docetaxel injection |
497 |
266 |
$54K |
| 84403 |
|
5,417 |
4,927 |
$54K |
| J9267 |
Paclitaxel injection |
8,714 |
3,855 |
$51K |
| Q0162 |
Ondansetron oral |
18,200 |
9,922 |
$48K |
| 70491 |
|
384 |
364 |
$48K |
| J9045 |
Carboplatin injection |
6,334 |
4,258 |
$44K |
| 88108 |
|
507 |
382 |
$42K |
| J9190 |
Fluorouracil injection |
15,353 |
6,368 |
$40K |
| 88313 |
|
2,050 |
1,541 |
$37K |
| 80197 |
|
3,989 |
2,023 |
$37K |
| 85610 |
|
8,068 |
6,254 |
$36K |
| 72197 |
|
104 |
101 |
$36K |
| 81001 |
|
10,020 |
7,804 |
$35K |
| 86803 |
|
2,162 |
1,880 |
$34K |
| J2405 |
Ondansetron hcl injection |
9,439 |
5,436 |
$34K |
| 82746 |
|
3,923 |
3,766 |
$34K |
| J9173 |
Inj., durvalumab, 10 mg |
34 |
24 |
$33K |
| 88341 |
|
250 |
230 |
$33K |
| ATP16 |
|
4,609 |
2,637 |
$32K |
| 86141 |
|
3,229 |
2,772 |
$32K |
| 82150 |
|
4,215 |
2,511 |
$31K |
| 88262 |
|
233 |
204 |
$31K |
| 80061 |
|
3,577 |
3,146 |
$30K |
| 71046 |
|
1,252 |
1,136 |
$29K |
| J9145 |
Injection, daratumumab 10 mg |
74 |
26 |
$29K |
| 85045 |
|
9,867 |
7,445 |
$29K |
| 77049 |
|
38 |
37 |
$29K |
| 96376 |
|
4,444 |
3,396 |
$28K |
| 84550 |
|
11,397 |
7,259 |
$28K |
| 86360 |
|
887 |
770 |
$28K |
| 86704 |
|
2,005 |
1,757 |
$27K |
| 82232 |
|
3,384 |
2,935 |
$27K |
| 36593 |
|
649 |
587 |
$27K |
| 87340 |
|
2,425 |
2,126 |
$27K |
| 82105 |
|
2,171 |
1,812 |
$26K |
| J9370 |
Vincristine sulfate 1 mg inj |
5,792 |
3,710 |
$25K |
| 90686 |
|
1,536 |
1,445 |
$25K |
| 85730 |
|
5,341 |
4,276 |
$24K |
| J9000 |
Doxorubicin hcl injection |
3,021 |
1,912 |
$24K |
| 82565 |
|
6,022 |
4,651 |
$24K |
| 83690 |
|
3,300 |
2,205 |
$22K |
| J8540 |
Oral dexamethasone |
30,171 |
15,784 |
$22K |
| 88311 |
|
1,559 |
1,300 |
$22K |
| 82247 |
|
5,724 |
2,899 |
$22K |
| 87635 |
|
122 |
106 |
$22K |
| 99195 |
|
744 |
595 |
$21K |
| 97802 |
|
379 |
343 |
$21K |
| J1190 |
Dexrazoxane hcl injection |
20 |
13 |
$21K |
| 87086 |
|
2,680 |
2,350 |
$19K |
| J1720 |
Hydrocortisone sodium succ i |
3,239 |
2,134 |
$19K |
| 81206 |
|
225 |
198 |
$19K |
| 89051 |
|
1,055 |
668 |
$19K |
| ATP17 |
|
2,844 |
1,678 |
$19K |
| J1200 |
Diphenhydramine hcl injectio |
10,233 |
6,075 |
$18K |
| 84450 |
|
4,440 |
2,364 |
$18K |
| 77387 |
|
668 |
79 |
$17K |
| J9999 |
Chemotherapy drug |
156 |
125 |
$17K |
| J1100 |
Dexamethasone sodium phos |
11,971 |
6,782 |
$17K |
| 81003 |
|
3,475 |
2,112 |
$17K |
| 86355 |
|
651 |
575 |
$16K |
| J9075 |
Inj, cyclophosphamide, nos |
148 |
101 |
$16K |
| J1439 |
Inj ferric carboxymaltos 1mg |
18 |
13 |
$15K |
| J3475 |
Inj magnesium sulfate |
9,955 |
5,426 |
$15K |
| 0002A |
|
766 |
732 |
$15K |
| 86706 |
|
1,958 |
1,788 |
$15K |
| 77062 |
|
138 |
132 |
$14K |
| 77066 |
Tomosynthesis, mammo |
770 |
736 |
$14K |
| 86357 |
|
601 |
527 |
$14K |
| 85055 |
|
495 |
219 |
$14K |
| 77065 |
Tomosynthesis, mammo |
428 |
415 |
$13K |
| 99442 |
|
166 |
140 |
$12K |
| 0001A |
|
780 |
750 |
$12K |
| 83036 |
|
2,203 |
2,046 |
$12K |
| 84520 |
|
3,167 |
2,457 |
$11K |
| J9060 |
Cisplatin 10 mg injection |
2,177 |
1,053 |
$10K |
| 81450 |
|
60 |
53 |
$10K |
| 87449 |
|
737 |
440 |
$10K |
| 86140 |
|
1,407 |
1,198 |
$9K |
| 77061 |
|
100 |
99 |
$9K |
| 80051 |
|
529 |
382 |
$8K |
| J9250 |
Methotrexate sodium inj |
3,144 |
1,594 |
$8K |
| ATP03 |
|
2,978 |
2,027 |
$8K |
| 85652 |
|
3,072 |
2,690 |
$8K |
| J3480 |
Inj potassium chloride |
5,475 |
2,844 |
$8K |
| 84466 |
|
1,834 |
1,684 |
$8K |
| 82670 |
|
349 |
334 |
$8K |
| 87305 |
|
624 |
371 |
$8K |
| 90471 |
|
1,613 |
1,465 |
$7K |
| 82533 |
|
403 |
344 |
$7K |
| J0461 |
Atropine sulfate injection |
4,342 |
2,387 |
$7K |
| ATP09 |
|
1,116 |
607 |
$7K |
| 82550 |
|
1,685 |
1,236 |
$7K |
| 84156 |
|
3,151 |
2,519 |
$6K |
| 96523 |
|
157 |
146 |
$6K |
| 87798 |
|
71 |
57 |
$6K |
| 82570 |
|
2,386 |
1,820 |
$6K |
| J9071 |
Inj cyclophosphamd auromedic |
102 |
54 |
$6K |
| 82947 |
|
1,012 |
748 |
$5K |
| 81265 |
|
46 |
37 |
$5K |
| 74176 |
|
96 |
93 |
$5K |
| 86335 |
|
914 |
801 |
$5K |
| 83001 |
|
309 |
291 |
$5K |
| 83010 |
|
900 |
771 |
$5K |
| J9181 |
Etoposide injection |
1,063 |
298 |
$5K |
| 94010 |
|
219 |
208 |
$5K |
| 86356 |
|
112 |
80 |
$5K |
| Q0163 |
Diphenhydramine hcl 50mg |
8,640 |
5,025 |
$4K |
| 36591 |
|
460 |
323 |
$4K |
| 94726 |
|
134 |
126 |
$4K |
| 86769 |
|
246 |
208 |
$4K |
| 83789 |
|
252 |
242 |
$4K |
| ATP02 |
|
1,237 |
914 |
$4K |
| 85044 |
|
1,295 |
1,093 |
$4K |
| G0008 |
Admin influenza virus vac |
995 |
947 |
$4K |
| J2920 |
Methylprednisolone injection |
1,203 |
888 |
$3K |
| 94729 |
|
135 |
127 |
$3K |
| 81267 |
|
78 |
63 |
$3K |
| 84166 |
|
1,092 |
971 |
$3K |
| J9260 |
Inj methotrexate sodium 50mg |
525 |
258 |
$3K |
| M0247 |
Sotrovimab infusion |
12 |
12 |
$3K |
| 86644 |
|
134 |
109 |
$3K |
| J1170 |
Hydromorphone injection |
916 |
583 |
$3K |
| G0279 |
Tomosynthesis, mammo |
162 |
149 |
$3K |
| 87040 |
|
254 |
174 |
$3K |
| 81025 |
|
344 |
253 |
$3K |
| 87389 |
|
161 |
147 |
$2K |
| 0003A |
|
144 |
143 |
$2K |
| 96040 |
|
26 |
24 |
$2K |
| 90662 |
|
364 |
342 |
$2K |
| J2704 |
Inj, propofol, 10 mg |
781 |
589 |
$2K |
| ATP18 |
|
300 |
167 |
$2K |
| 88381 |
|
39 |
38 |
$2K |
| 85097 |
|
96 |
80 |
$2K |
| 86316 |
|
223 |
194 |
$2K |
| 77300 |
|
12 |
12 |
$2K |
| 86665 |
|
65 |
39 |
$2K |
| J9100 |
Cytarabine hcl 100 mg inj |
262 |
114 |
$2K |
| 90677 |
|
13 |
12 |
$2K |
| ATP08 |
|
284 |
217 |
$2K |
| 82668 |
|
302 |
285 |
$2K |
| J2916 |
Na ferric gluconate complex |
25 |
13 |
$2K |
| 0004A |
|
105 |
90 |
$2K |
| S0028 |
Injection, famotidine, 20 mg |
52 |
29 |
$1K |
| J3420 |
Vitamin b12 injection |
5,079 |
4,343 |
$1K |
| 36592 |
|
160 |
96 |
$1K |
| 99417 |
Prolong home eval add 15m |
31 |
27 |
$1K |
| 82610 |
|
159 |
145 |
$1K |
| 87081 |
|
518 |
478 |
$1K |
| 72158 |
|
12 |
12 |
$1K |
| 81268 |
|
46 |
24 |
$1K |
| 88360 |
|
39 |
37 |
$1K |
| 86922 |
|
205 |
116 |
$1K |
| M0220 |
Tixagev and cilgav inj |
16 |
14 |
$1K |
| 87631 |
|
35 |
26 |
$1K |
| 86945 |
|
44 |
26 |
$1K |
| 86777 |
|
53 |
50 |
$995.93 |
| 84481 |
|
134 |
109 |
$918.32 |
| J3010 |
Fentanyl citrate injection |
1,002 |
779 |
$870.79 |
| 84155 |
|
1,259 |
1,117 |
$858.25 |
| U0003 |
Cov-19 amp prb hgh thruput |
29 |
27 |
$825.00 |
| Q3014 |
Telehealth facility fee |
1,577 |
1,444 |
$816.74 |
| 83516 |
|
112 |
65 |
$777.63 |
| J2060 |
Lorazepam injection |
823 |
534 |
$772.81 |
| 90656 |
|
49 |
45 |
$717.46 |
| 86359 |
|
56 |
52 |
$711.26 |
| ATP07 |
|
133 |
94 |
$710.64 |
| Q0164 |
Prochlorperazine maleate 5mg |
2,648 |
1,520 |
$676.27 |
| 84478 |
|
250 |
159 |
$653.96 |
| 84460 |
|
145 |
102 |
$628.85 |
| 88271 |
|
88 |
65 |
$613.55 |
| 86787 |
|
40 |
38 |
$604.61 |
| 82043 |
|
198 |
168 |
$569.13 |
| 88275 |
|
21 |
13 |
$538.46 |
| 93000 |
|
13 |
13 |
$532.81 |
| 90472 |
|
185 |
168 |
$485.08 |
| 84484 |
|
31 |
25 |
$413.42 |
| A9503 |
Tc99m medronate |
622 |
592 |
$412.83 |
| 87077 |
|
78 |
62 |
$380.46 |
| 80307 |
|
17 |
14 |
$380.40 |
| 85384 |
|
78 |
59 |
$361.78 |
| 86039 |
|
41 |
41 |
$319.32 |
| J2919 |
Inj, methylpred sod succ 5mg |
247 |
151 |
$289.75 |
| 86902 |
|
32 |
25 |
$276.01 |
| U0005 |
Infec agen detec ampli probe |
29 |
27 |
$275.00 |
| 87186 |
|
13 |
12 |
$257.11 |
| 83021 |
|
24 |
24 |
$223.02 |
| 90670 |
|
19 |
12 |
$213.35 |
| 83883 |
|
32 |
25 |
$205.20 |
| 86664 |
|
13 |
13 |
$202.41 |
| 88365 |
|
15 |
12 |
$143.21 |
| 83880 |
|
20 |
13 |
$138.48 |
| 84480 |
|
27 |
25 |
$137.75 |
| 82310 |
|
183 |
125 |
$136.37 |
| 0077U |
|
463 |
430 |
$116.94 |
| 83970 |
|
24 |
18 |
$109.23 |
| 86431 |
|
12 |
12 |
$75.50 |
| 83020 |
|
17 |
12 |
$68.10 |
| 82977 |
|
204 |
144 |
$62.70 |
| J2930 |
Methylprednisolone injection |
19 |
14 |
$58.55 |
| 85049 |
|
37 |
36 |
$44.99 |
| 82465 |
|
42 |
37 |
$44.88 |
| 91300 |
|
688 |
556 |
$40.50 |
| 82374 |
|
45 |
33 |
$25.14 |
| 84132 |
|
52 |
40 |
$24.39 |
| 85018 |
|
37 |
36 |
$23.76 |
| 85014 |
|
36 |
35 |
$21.60 |
| 85651 |
|
16 |
15 |
$18.25 |
| ATP13 |
|
15 |
13 |
$10.89 |
| 85041 |
|
13 |
13 |
$8.28 |
| 84295 |
|
17 |
16 |
$0.00 |
| J7030 |
Normal saline solution infus |
78 |
44 |
$0.00 |
| Q0220 |
Tixagev and cilgav, 300mg |
16 |
14 |
$0.00 |
| 77417 |
|
76 |
36 |
$0.00 |
| J1940 |
Furosemide injection |
36 |
24 |
$0.00 |
| G0009 |
Admin pneumococcal vaccine |
12 |
12 |
$0.00 |
| J7512 |
Prednisone ir or dr oral 1mg |
12 |
12 |
$0.00 |