| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 80053 |
|
4,475 |
3,626 |
$400K |
| G0463 |
Hospital outpt clinic visit |
14,068 |
8,873 |
$381K |
| 16020 |
|
2,490 |
1,781 |
$257K |
| 99283 |
|
4,745 |
3,993 |
$255K |
| 97535 |
|
3,685 |
2,695 |
$186K |
| 36415 |
|
1,112 |
976 |
$141K |
| 81001 |
|
3,707 |
3,144 |
$74K |
| 99284 |
|
3,084 |
2,617 |
$73K |
| 15002 |
|
504 |
424 |
$54K |
| 99282 |
|
546 |
493 |
$37K |
| 87635 |
|
484 |
429 |
$34K |
| 80048 |
|
963 |
723 |
$26K |
| 96372 |
|
1,056 |
795 |
$21K |
| 96374 |
|
1,906 |
1,615 |
$20K |
| 87086 |
|
552 |
477 |
$18K |
| J7030 |
Normal saline solution infus |
3,527 |
2,741 |
$17K |
| 97162 |
|
841 |
735 |
$17K |
| 71046 |
|
381 |
332 |
$17K |
| Q4100 |
Skin substitute, nos |
1,211 |
1,023 |
$15K |
| 71045 |
|
1,225 |
950 |
$14K |
| U0003 |
Cov-19 amp prb hgh thruput |
94 |
78 |
$14K |
| 81025 |
|
2,351 |
2,005 |
$14K |
| G0378 |
Hospital observation per hr |
908 |
691 |
$13K |
| 15004 |
|
207 |
179 |
$12K |
| 93005 |
|
2,140 |
1,661 |
$12K |
| 87804 |
|
344 |
246 |
$12K |
| 97168 |
|
546 |
485 |
$9K |
| 99211 |
|
418 |
340 |
$9K |
| 83690 |
|
1,818 |
1,521 |
$8K |
| 87077 |
|
305 |
242 |
$8K |
| 85027 |
|
6,541 |
4,890 |
$8K |
| 97166 |
|
536 |
482 |
$7K |
| 0479T |
|
130 |
119 |
$4K |
| 97165 |
|
200 |
179 |
$4K |
| J2405 |
Ondansetron hcl injection |
1,709 |
1,322 |
$4K |
| 99285 |
|
142 |
121 |
$3K |
| J3490 |
Drugs unclassified injection |
1,330 |
1,087 |
$3K |
| 84484 |
|
921 |
599 |
$3K |
| 96375 |
|
475 |
372 |
$3K |
| C5273 |
Low cost skin substitute app |
38 |
37 |
$2K |
| J7120 |
Ringers lactate infusion |
343 |
270 |
$2K |
| 99281 |
|
14 |
12 |
$2K |
| J2250 |
Inj midazolam hydrochloride |
2,065 |
1,643 |
$2K |
| 87070 |
|
68 |
53 |
$2K |
| 99213 |
|
76 |
65 |
$1K |
| 97161 |
|
79 |
69 |
$1K |
| 70450 |
|
44 |
38 |
$984.91 |
| 97164 |
|
59 |
54 |
$875.86 |
| J7050 |
Normal saline solution infus |
51 |
36 |
$683.00 |
| 99203 |
|
28 |
28 |
$430.47 |
| 74176 |
|
53 |
48 |
$325.02 |
| 84703 |
|
33 |
29 |
$261.53 |
| 87880 |
|
14 |
14 |
$250.00 |
| J2270 |
Morphine sulfate injection |
489 |
375 |
$232.64 |
| 83880 |
|
94 |
66 |
$154.20 |
| J1885 |
Ketorolac tromethamine inj |
1,049 |
682 |
$139.30 |
| J1100 |
Dexamethasone sodium phos |
850 |
553 |
$120.60 |
| 87186 |
|
218 |
170 |
$90.36 |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
126 |
93 |
$86.27 |
| 86850 |
|
179 |
151 |
$80.10 |
| 82247 |
|
18 |
13 |
$56.30 |
| 88305 |
|
27 |
24 |
$53.41 |
| 85610 |
|
875 |
665 |
$47.81 |
| 86900 |
|
185 |
157 |
$34.87 |
| 85730 |
|
762 |
564 |
$31.27 |
| 86901 |
|
185 |
157 |
$25.23 |
| J1170 |
Hydromorphone injection |
1,330 |
1,038 |
$15.26 |
| J3010 |
Fentanyl citrate injection |
1,290 |
941 |
$8.23 |
| 87205 |
|
48 |
40 |
$0.00 |
| J0696 |
Ceftriaxone sodium injection |
60 |
54 |
$0.00 |
| 87490 |
|
14 |
12 |
$0.00 |
| J2704 |
Inj, propofol, 10 mg |
436 |
341 |
$0.00 |
| 82550 |
|
36 |
25 |
$0.00 |
| A9270 |
Non-covered item or service |
399 |
126 |
$0.00 |
| 84443 |
|
51 |
49 |
$0.00 |
| 83735 |
|
109 |
66 |
$0.00 |
| 15275 |
|
73 |
69 |
$0.00 |
| A6208 |
Contact layer > 48 sq in |
253 |
168 |
$0.00 |
| Q0162 |
Ondansetron oral |
14 |
13 |
$0.00 |
| 87590 |
|
14 |
12 |
$0.00 |
| 83605 |
|
22 |
13 |
$0.00 |
| 15271 |
|
12 |
12 |
$0.00 |
| 96376 |
|
19 |
13 |
$0.00 |
| J1596 |
Inj, glycopyrrolate, 0.1 mg |
240 |
116 |
$0.00 |
| 97760 |
|
18 |
13 |
$0.00 |
| 85007 |
|
13 |
13 |
$0.00 |
| C5275 |
Low cost skin substitute app |
27 |
25 |
$0.00 |
| 15274 |
|
22 |
14 |
$0.00 |
| 15273 |
|
27 |
26 |
$0.00 |
| S0119 |
Ondansetron 4 mg |
13 |
12 |
$0.00 |
| 99204 |
|
29 |
26 |
$0.00 |