| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 95812 |
|
209 |
209 |
$454K |
| 93325 |
|
247 |
240 |
$319K |
| 42820 |
|
86 |
85 |
$226K |
| 93005 |
|
571 |
564 |
$214K |
| 94010 |
|
210 |
205 |
$179K |
| 99284 |
|
360 |
352 |
$151K |
| 99283 |
|
740 |
720 |
$136K |
| 69436 |
|
39 |
39 |
$113K |
| 93306 |
|
47 |
47 |
$56K |
| 96365 |
|
108 |
99 |
$42K |
| 92567 |
|
435 |
429 |
$39K |
| 93304 |
|
14 |
12 |
$24K |
| OP370 |
|
1,228 |
1,222 |
$19K |
| OP710 |
|
1,227 |
1,218 |
$17K |
| 80053 |
|
621 |
388 |
$16K |
| D1120 |
|
471 |
457 |
$14K |
| 92579 |
|
42 |
42 |
$12K |
| 85025 |
|
1,001 |
797 |
$10K |
| 92555 |
|
119 |
118 |
$8K |
| D0120 |
|
416 |
401 |
$8K |
| 71046 |
|
176 |
175 |
$6K |
| 93321 |
|
31 |
29 |
$6K |
| 85055 |
|
76 |
47 |
$5K |
| OP272 |
|
1,209 |
1,175 |
$5K |
| D1208 |
|
189 |
184 |
$3K |
| D0272 |
|
197 |
195 |
$3K |
| 83735 |
|
289 |
180 |
$3K |
| 82977 |
|
228 |
131 |
$3K |
| 88304 |
|
198 |
197 |
$3K |
| 85045 |
|
250 |
240 |
$2K |
| 84100 |
|
310 |
188 |
$2K |
| 83615 |
|
217 |
130 |
$2K |
| D1206 |
|
96 |
96 |
$2K |
| OP270 |
|
395 |
375 |
$2K |
| 84550 |
|
203 |
118 |
$2K |
| 96375 |
|
16 |
13 |
$2K |
| OP250 |
|
1,881 |
1,499 |
$2K |
| 73521 |
|
12 |
12 |
$1K |
| J0131 |
Inj, acetaminophen (nos) |
636 |
618 |
$1K |
| J7050 |
Normal saline solution infus |
429 |
288 |
$1K |
| 82248 |
|
115 |
77 |
$1K |
| 85027 |
|
116 |
82 |
$925.90 |
| J7120 |
Ringers lactate infusion |
1,107 |
1,091 |
$435.14 |
| J1100 |
Dexamethasone sodium phos |
996 |
979 |
$254.65 |
| D0150 |
|
12 |
12 |
$240.00 |
| 85007 |
|
38 |
26 |
$187.46 |
| J2270 |
Morphine sulfate injection |
1,014 |
994 |
$143.78 |
| J2405 |
Ondansetron hcl injection |
1,012 |
965 |
$139.80 |
| J2704 |
Inj, propofol, 10 mg |
40 |
39 |
$124.63 |
| 87880 |
|
25 |
24 |
$106.47 |
| J1885 |
Ketorolac tromethamine inj |
84 |
79 |
$34.31 |
| J3010 |
Fentanyl citrate injection |
398 |
394 |
$31.95 |
| A9579 |
Gad-base mr contrast nos,1ml |
12 |
12 |
$31.93 |
| OP259 |
|
501 |
487 |
$26.90 |
| J3490 |
Drugs unclassified injection |
920 |
437 |
$24.43 |
| J8499 |
Oral prescrip drug non chemo |
729 |
571 |
$17.22 |
| J0690 |
Cefazolin sodium injection |
133 |
133 |
$16.07 |
| J2250 |
Inj midazolam hydrochloride |
29 |
28 |
$5.57 |
| D1330 |
|
109 |
103 |
$0.00 |