| Code | Description | Claims | Beneficiaries | Total Paid |
| 0131 |
Inj, acetaminophen (hikma) |
505 |
486 |
$1.26M |
| 0450 |
|
24,255 |
22,623 |
$1.10M |
| 80307 |
|
8,022 |
7,439 |
$373K |
| 0209 |
|
348 |
335 |
$333K |
| 0360 |
|
1,897 |
1,722 |
$197K |
| 87635 |
|
3,941 |
3,615 |
$150K |
| Z7502 |
|
3,691 |
3,640 |
$137K |
| 70450 |
|
1,346 |
1,300 |
$121K |
| 99281 |
|
2,213 |
2,070 |
$115K |
| 80048 |
|
10,258 |
9,514 |
$105K |
| 96374 |
|
2,162 |
2,065 |
$102K |
| 85025 |
|
15,311 |
13,981 |
$100K |
| 74176 |
|
925 |
896 |
$82K |
| 71045 |
|
7,231 |
6,859 |
$82K |
| 96365 |
|
1,312 |
1,277 |
$76K |
| 93005 |
|
4,060 |
3,833 |
$76K |
| 96372 |
|
3,376 |
3,241 |
$63K |
| 99199 |
|
1,939 |
1,730 |
$62K |
| 80053 |
|
4,720 |
4,415 |
$56K |
| 96360 |
|
1,210 |
1,170 |
$54K |
| 0250 |
|
5,348 |
3,890 |
$50K |
| U0002 |
Covid-19 lab test non-cdc |
1,170 |
1,094 |
$44K |
| 84484 |
|
6,044 |
5,666 |
$44K |
| 0710 |
|
2,522 |
2,317 |
$43K |
| C9803 |
Hopd covid-19 spec collect |
2,453 |
2,293 |
$42K |
| 0121 |
|
12 |
12 |
$38K |
| 96375 |
|
1,119 |
1,059 |
$33K |
| J3490 |
Drugs unclassified injection |
4,644 |
3,738 |
$32K |
| 83880 |
|
1,398 |
1,323 |
$28K |
| J7030 |
Normal saline solution infus |
3,828 |
3,551 |
$23K |
| 36415 |
|
9,540 |
8,381 |
$23K |
| 81025 |
|
4,734 |
4,558 |
$22K |
| J1885 |
Ketorolac tromethamine inj |
2,386 |
2,273 |
$22K |
| 99285 |
|
206 |
200 |
$22K |
| 0760 |
|
351 |
179 |
$20K |
| 96361 |
|
1,146 |
1,108 |
$19K |
| J0696 |
Ceftriaxone sodium injection |
1,574 |
1,506 |
$19K |
| 83690 |
|
3,366 |
3,200 |
$17K |
| 85730 |
|
3,715 |
3,530 |
$16K |
| 81001 |
|
6,117 |
5,834 |
$16K |
| 83605 |
|
1,830 |
1,741 |
$15K |
| 87040 |
|
1,310 |
1,225 |
$14K |
| 99283 |
|
215 |
211 |
$13K |
| 82550 |
|
2,524 |
2,404 |
$11K |
| 85610 |
|
3,794 |
3,608 |
$11K |
| J2405 |
Ondansetron hcl injection |
1,791 |
1,666 |
$11K |
| 99284 |
|
205 |
200 |
$10K |
| 81003 |
|
6,096 |
5,824 |
$10K |
| 80076 |
|
1,342 |
1,294 |
$9K |
| 87088 |
|
1,680 |
1,611 |
$9K |
| J2704 |
Inj, propofol, 10 mg |
1,546 |
1,422 |
$8K |
| 0241U |
|
70 |
69 |
$7K |
| 82150 |
|
1,413 |
1,355 |
$7K |
| 43239 |
|
233 |
230 |
$6K |
| 86328 |
|
171 |
167 |
$6K |
| 71046 |
|
318 |
308 |
$6K |
| 87804 |
|
715 |
700 |
$4K |
| 0270 |
|
1,972 |
1,512 |
$4K |
| 82948 |
|
392 |
369 |
$4K |
| 88305 |
|
412 |
396 |
$4K |
| 45378 |
|
134 |
133 |
$4K |
| 83036 |
|
438 |
419 |
$4K |
| 87077 |
|
481 |
461 |
$3K |
| J2270 |
Morphine sulfate injection |
364 |
303 |
$3K |
| 87186 |
|
217 |
209 |
$2K |
| 87811 |
|
79 |
74 |
$2K |
| J2001 |
Lidocaine injection |
576 |
547 |
$2K |
| J7120 |
Ringers lactate infusion |
321 |
295 |
$2K |
| 82140 |
|
190 |
185 |
$2K |
| 99406 |
|
153 |
147 |
$2K |
| 74018 |
|
115 |
105 |
$1K |
| 82553 |
|
176 |
163 |
$1K |
| 94640 |
|
108 |
74 |
$1K |
| 84703 |
|
210 |
205 |
$927.42 |
| 71010 |
|
64 |
40 |
$893.40 |
| 72100 |
|
41 |
39 |
$865.83 |
| 73560 |
|
51 |
49 |
$808.94 |
| 0361 |
|
12 |
12 |
$803.94 |
| Z7610 |
|
57 |
55 |
$726.05 |
| 88312 |
|
115 |
113 |
$616.82 |
| 99282 |
|
13 |
12 |
$454.88 |
| J2250 |
Inj midazolam hydrochloride |
105 |
104 |
$400.50 |
| 94644 |
|
25 |
24 |
$381.36 |
| 86140 |
|
94 |
89 |
$378.84 |
| 80061 |
|
41 |
41 |
$349.66 |
| J3010 |
Fentanyl citrate injection |
117 |
113 |
$324.17 |
| 87420 |
|
62 |
61 |
$282.64 |
| 85651 |
|
117 |
114 |
$252.75 |
| J2060 |
Lorazepam injection |
54 |
49 |
$218.26 |
| 83735 |
|
40 |
38 |
$207.03 |
| A4649 |
Surgical supplies |
182 |
124 |
$187.81 |
| 85378 |
|
26 |
24 |
$164.36 |
| 87338 |
|
28 |
27 |
$155.10 |
| 73120 |
|
13 |
13 |
$122.74 |
| J2930 |
Methylprednisolone injection |
12 |
12 |
$121.66 |
| 90471 |
|
24 |
24 |
$91.41 |
| J1200 |
Diphenhydramine hcl injectio |
15 |
15 |
$68.22 |
| 0324 |
|
559 |
509 |
$43.05 |
| J2765 |
Metoclopramide hcl injection |
12 |
12 |
$38.70 |
| 0636 |
|
940 |
860 |
$30.27 |
| 87081 |
|
14 |
14 |
$27.06 |
| 0370 |
|
135 |
125 |
$0.00 |
| 0307 |
|
358 |
333 |
$0.00 |
| 0305 |
|
1,007 |
927 |
$0.00 |
| 0306 |
|
693 |
635 |
$0.00 |
| 0301 |
|
1,012 |
932 |
$0.00 |
| 0420 |
|
190 |
180 |
$0.00 |
| 0258 |
|
63 |
61 |
$0.00 |
| 0300 |
|
1,014 |
935 |
$0.00 |
| 0730 |
|
268 |
257 |
$0.00 |
| 0320 |
|
74 |
69 |
$0.00 |
| 0402 |
|
91 |
87 |
$0.00 |
| 0302 |
|
117 |
110 |
$0.00 |
| 0483 |
|
25 |
25 |
$0.00 |