| Code | Description | Claims | Beneficiaries | Total Paid |
| 0450 |
|
12,848 |
11,579 |
$702K |
| 74177 |
|
1,020 |
993 |
$289K |
| 96374 |
|
2,096 |
1,849 |
$167K |
| 87637 |
|
1,138 |
1,124 |
$136K |
| 0762 |
|
229 |
127 |
$118K |
| 93005 |
|
3,698 |
3,401 |
$94K |
| 0202U |
|
156 |
154 |
$93K |
| 96375 |
|
1,550 |
1,359 |
$85K |
| 80053 |
|
8,198 |
7,323 |
$73K |
| 70450 |
|
913 |
895 |
$69K |
| 96372 |
|
1,516 |
1,389 |
$59K |
| 85025 |
|
8,956 |
7,712 |
$58K |
| 87635 |
|
627 |
609 |
$53K |
| 96361 |
|
1,087 |
985 |
$48K |
| 87636 |
|
374 |
373 |
$45K |
| 74176 |
|
314 |
309 |
$39K |
| 96365 |
|
446 |
382 |
$38K |
| 0250 |
|
9,975 |
5,463 |
$38K |
| 80307 |
|
541 |
520 |
$37K |
| 71046 |
|
1,646 |
1,588 |
$37K |
| 72125 |
|
322 |
318 |
$35K |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
2,541 |
1,404 |
$34K |
| 71275 |
|
132 |
131 |
$31K |
| 77067 |
|
182 |
182 |
$30K |
| 96360 |
|
344 |
340 |
$29K |
| 0750 |
|
204 |
204 |
$29K |
| J2405 |
Ondansetron hcl injection |
1,146 |
1,018 |
$28K |
| 76856 |
|
299 |
292 |
$25K |
| 84484 |
|
3,268 |
2,515 |
$24K |
| 71045 |
|
1,840 |
1,723 |
$22K |
| 87651 |
|
502 |
497 |
$21K |
| 83690 |
|
3,086 |
2,873 |
$20K |
| J1100 |
Dexamethasone sodium phos |
364 |
350 |
$20K |
| 93971 |
|
169 |
167 |
$19K |
| 76830 |
|
212 |
209 |
$18K |
| 83880 |
|
714 |
676 |
$18K |
| J1885 |
Ketorolac tromethamine inj |
1,353 |
1,289 |
$18K |
| J0696 |
Ceftriaxone sodium injection |
519 |
462 |
$17K |
| 76705 |
|
238 |
233 |
$17K |
| 76801 |
|
194 |
164 |
$16K |
| J7030 |
Normal saline solution infus |
1,297 |
1,221 |
$13K |
| 70498 |
|
51 |
51 |
$13K |
| 70496 |
|
49 |
49 |
$13K |
| 81001 |
|
4,254 |
3,965 |
$13K |
| 0510 |
|
376 |
269 |
$12K |
| 71260 |
|
63 |
62 |
$12K |
| 82077 |
|
455 |
408 |
$10K |
| 87491 |
|
221 |
217 |
$10K |
| 87591 |
|
221 |
217 |
$10K |
| 72148 |
|
64 |
64 |
$9K |
| 72131 |
|
65 |
64 |
$9K |
| 73562 |
|
326 |
321 |
$9K |
| 70551 |
|
54 |
54 |
$9K |
| 73630 |
|
258 |
257 |
$8K |
| 77063 |
|
181 |
181 |
$8K |
| 76817 |
|
82 |
66 |
$7K |
| J7120 |
Ringers lactate infusion |
716 |
647 |
$7K |
| J2270 |
Morphine sulfate injection |
496 |
439 |
$7K |
| 73030 |
|
266 |
262 |
$7K |
| 70486 |
|
47 |
47 |
$7K |
| 84443 |
|
401 |
393 |
$6K |
| J2250 |
Inj midazolam hydrochloride |
271 |
266 |
$6K |
| 87040 |
|
606 |
454 |
$6K |
| 83605 |
|
748 |
587 |
$6K |
| 83735 |
|
1,121 |
1,013 |
$6K |
| 80143 |
|
238 |
221 |
$6K |
| 81025 |
|
1,184 |
1,151 |
$6K |
| 80179 |
|
231 |
220 |
$6K |
| 71250 |
|
68 |
68 |
$6K |
| 76700 |
|
70 |
69 |
$5K |
| 93970 |
|
26 |
25 |
$5K |
| 73610 |
|
166 |
164 |
$5K |
| 96366 |
|
88 |
78 |
$5K |
| J1170 |
Hydromorphone injection |
300 |
244 |
$5K |
| 73130 |
|
142 |
142 |
$5K |
| J0131 |
Inj, acetaminophen (nos) |
120 |
60 |
$4K |
| 82803 |
|
332 |
311 |
$4K |
| J1953 |
Levetiracetam injection |
27 |
12 |
$4K |
| 76770 |
|
50 |
50 |
$4K |
| J3010 |
Fentanyl citrate injection |
347 |
324 |
$4K |
| 87086 |
|
530 |
521 |
$4K |
| 85379 |
|
333 |
327 |
$4K |
| J2001 |
Lidocaine injection |
225 |
188 |
$4K |
| 72100 |
|
108 |
108 |
$4K |
| 84145 |
|
145 |
143 |
$3K |
| 70491 |
|
18 |
18 |
$3K |
| 43239 |
|
60 |
60 |
$3K |
| 73502 |
|
79 |
79 |
$3K |
| J2919 |
Inj, methylpred sod succ 5mg |
56 |
52 |
$3K |
| 90715 |
|
45 |
45 |
$3K |
| 82947 |
|
578 |
523 |
$3K |
| J7040 |
Normal saline solution infus |
252 |
249 |
$3K |
| 73110 |
|
97 |
97 |
$3K |
| G0378 |
Hospital observation per hr |
50 |
40 |
$3K |
| J2765 |
Metoclopramide hcl injection |
320 |
303 |
$3K |
| 72141 |
|
13 |
12 |
$3K |
| J1200 |
Diphenhydramine hcl injectio |
344 |
311 |
$3K |
| 75571 |
|
30 |
30 |
$3K |
| 76870 |
|
42 |
40 |
$2K |
| 85610 |
|
894 |
826 |
$2K |
| 85730 |
|
565 |
540 |
$2K |
| 0361 |
|
15 |
14 |
$2K |
| 87186 |
|
208 |
208 |
$2K |
| 99284 |
|
409 |
387 |
$2K |
| 74018 |
|
79 |
79 |
$2K |
| 88305 |
|
139 |
88 |
$2K |
| 73080 |
|
56 |
55 |
$2K |
| 73590 |
|
76 |
75 |
$2K |
| 87077 |
|
189 |
188 |
$2K |
| 87502 |
|
16 |
16 |
$2K |
| 80048 |
|
311 |
256 |
$2K |
| 84702 |
|
96 |
82 |
$2K |
| 86901 |
|
318 |
286 |
$1K |
| 88342 |
|
68 |
68 |
$1K |
| 72110 |
|
36 |
33 |
$1K |
| 86900 |
|
314 |
280 |
$1K |
| 77085 |
|
24 |
24 |
$1K |
| 81003 |
|
546 |
524 |
$1K |
| 86850 |
|
205 |
195 |
$1K |
| 86140 |
|
249 |
248 |
$1K |
| 73090 |
|
46 |
46 |
$1K |
| 99285 |
|
325 |
297 |
$1K |
| 88313 |
|
69 |
69 |
$1K |
| J2272 |
Inj, morphine (fresenius) |
48 |
44 |
$1K |
| 73140 |
|
42 |
42 |
$947.76 |
| 99283 |
|
290 |
276 |
$943.01 |
| 73552 |
|
28 |
28 |
$904.64 |
| J1815 |
Insulin injection |
65 |
46 |
$860.00 |
| 82330 |
|
56 |
55 |
$837.20 |
| J3475 |
Inj magnesium sulfate |
35 |
31 |
$815.43 |
| J3301 |
Triamcinolone acet inj nos |
15 |
14 |
$778.52 |
| J2060 |
Lorazepam injection |
74 |
67 |
$774.76 |
| 72070 |
|
26 |
24 |
$761.96 |
| 84703 |
|
174 |
172 |
$729.35 |
| 73060 |
|
27 |
27 |
$728.46 |
| J0780 |
Prochlorperazine injection |
50 |
48 |
$693.57 |
| J1644 |
Inj heparin sodium per 1000u |
46 |
24 |
$647.04 |
| 96413 |
|
61 |
50 |
$518.45 |
| 72170 |
|
21 |
21 |
$509.28 |
| 83036 |
|
45 |
45 |
$463.93 |
| 90471 |
|
59 |
48 |
$451.16 |
| 87210 |
|
83 |
81 |
$421.58 |
| 84100 |
|
93 |
92 |
$410.67 |
| J3490 |
Drugs unclassified injection |
17 |
14 |
$398.21 |
| 84439 |
|
39 |
39 |
$379.64 |
| 82550 |
|
70 |
56 |
$344.05 |
| 72040 |
|
15 |
15 |
$327.30 |
| G0283 |
Elec stim other than wound |
75 |
27 |
$288.64 |
| 85652 |
|
96 |
96 |
$266.85 |
| 73660 |
|
12 |
12 |
$225.24 |
| 97140 |
|
35 |
15 |
$201.21 |
| 85651 |
|
70 |
69 |
$196.35 |
| J7611 |
Albuterol non-comp con |
105 |
98 |
$196.34 |
| S0164 |
Injection pantroprazole |
16 |
16 |
$189.11 |
| 86308 |
|
28 |
28 |
$181.25 |
| J2704 |
Inj, propofol, 10 mg |
29 |
27 |
$176.55 |
| 86592 |
|
37 |
36 |
$174.86 |
| 84132 |
|
34 |
32 |
$169.74 |
| 97110 |
|
55 |
25 |
$159.43 |
| 86331 |
|
16 |
16 |
$155.26 |
| J7050 |
Normal saline solution infus |
82 |
74 |
$117.72 |
| 87324 |
|
14 |
14 |
$113.07 |
| 87899 |
|
21 |
21 |
$104.03 |
| 84295 |
|
14 |
13 |
$73.50 |
| 36415 |
|
167 |
124 |
$68.29 |
| 82009 |
|
15 |
13 |
$67.56 |
| 0636 |
|
51 |
42 |
$21.88 |
| 87400 |
|
48 |
45 |
$17.99 |
| 0370 |
|
54 |
49 |
$0.00 |
| 0710 |
|
13 |
13 |
$0.00 |
| 0272 |
|
317 |
293 |
$0.00 |