| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99284 |
|
923 |
884 |
$156K |
| 99283 |
|
1,051 |
992 |
$108K |
| 99285 |
|
280 |
271 |
$95K |
| 96374 |
|
609 |
565 |
$51K |
| 96375 |
|
590 |
450 |
$17K |
| G0463 |
Hospital outpt clinic visit |
344 |
324 |
$15K |
| 71046 |
|
352 |
342 |
$11K |
| 82947 |
|
488 |
401 |
$7K |
| 96413 |
|
64 |
27 |
$7K |
| 74177 |
|
26 |
26 |
$3K |
| 70450 |
|
28 |
27 |
$3K |
| 96372 |
|
1,608 |
1,411 |
$2K |
| 96365 |
|
22 |
16 |
$2K |
| 99282 |
|
24 |
24 |
$1K |
| 96361 |
|
38 |
37 |
$915.64 |
| 90471 |
|
64 |
64 |
$428.40 |
| A9270 |
Non-covered item or service |
1,142 |
987 |
$115.26 |
| 93005 |
|
365 |
329 |
$29.05 |
| 84484 |
|
235 |
178 |
$0.00 |
| J2001 |
Lidocaine injection |
379 |
354 |
$0.00 |
| 82150 |
|
223 |
211 |
$0.00 |
| J1030 |
Methylprednisolone 40 mg inj |
14 |
13 |
$0.00 |
| J1170 |
Hydromorphone injection |
91 |
76 |
$0.00 |
| J1885 |
Ketorolac tromethamine inj |
1,294 |
1,172 |
$0.00 |
| 85025 |
|
796 |
717 |
$0.00 |
| 80048 |
|
474 |
390 |
$0.00 |
| 84075 |
|
212 |
195 |
$0.00 |
| 81001 |
|
394 |
385 |
$0.00 |
| 83735 |
|
250 |
196 |
$0.00 |
| 85730 |
|
239 |
222 |
$0.00 |
| 88305 |
|
55 |
55 |
$0.00 |
| J7050 |
Normal saline solution infus |
189 |
125 |
$0.00 |
| J3010 |
Fentanyl citrate injection |
177 |
175 |
$0.00 |
| 83690 |
|
240 |
226 |
$0.00 |
| J3490 |
Drugs unclassified injection |
837 |
556 |
$0.00 |
| J1100 |
Dexamethasone sodium phos |
543 |
439 |
$0.00 |
| J2704 |
Inj, propofol, 10 mg |
268 |
264 |
$0.00 |
| 80051 |
|
208 |
196 |
$0.00 |
| 85027 |
|
17 |
12 |
$0.00 |
| 94640 |
|
55 |
39 |
$0.00 |
| J2250 |
Inj midazolam hydrochloride |
94 |
92 |
$0.00 |
| 83605 |
|
14 |
14 |
$0.00 |
| J7620 |
Albuterol ipratrop non-comp |
27 |
26 |
$0.00 |
| J0696 |
Ceftriaxone sodium injection |
57 |
48 |
$0.00 |
| J0690 |
Cefazolin sodium injection |
16 |
12 |
$0.00 |
| 82565 |
|
244 |
234 |
$0.00 |
| 84450 |
|
249 |
237 |
$0.00 |
| J2405 |
Ondansetron hcl injection |
628 |
501 |
$0.00 |
| 84520 |
|
267 |
256 |
$0.00 |
| 90715 |
|
56 |
56 |
$0.00 |
| 84460 |
|
263 |
251 |
$0.00 |
| J2270 |
Morphine sulfate injection |
125 |
110 |
$0.00 |
| J7030 |
Normal saline solution infus |
1,029 |
909 |
$0.00 |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
107 |
107 |
$0.00 |
| 81025 |
|
512 |
491 |
$0.00 |
| S5000 |
Prescription drug, generic |
126 |
100 |
$0.00 |
| 85610 |
|
267 |
250 |
$0.00 |
| J1200 |
Diphenhydramine hcl injectio |
78 |
70 |
$0.00 |
| 81003 |
|
208 |
206 |
$0.00 |
| 82247 |
|
249 |
238 |
$0.00 |
| J2930 |
Methylprednisolone injection |
25 |
24 |
$0.00 |
| 84100 |
|
207 |
174 |
$0.00 |
| 80307 |
|
14 |
13 |
$0.00 |
| 87502 |
|
17 |
17 |
$0.00 |
| J3301 |
Triamcinolone acet inj nos |
12 |
12 |
$0.00 |