| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 97110 |
|
1,094 |
322 |
$55K |
| 80053 |
|
1,519 |
1,277 |
$44K |
| 0241U |
|
484 |
423 |
$42K |
| 70450 |
|
239 |
220 |
$21K |
| 80307 |
|
311 |
249 |
$19K |
| 96365 |
|
337 |
238 |
$18K |
| 92507 |
|
513 |
150 |
$16K |
| 97530 |
|
333 |
104 |
$15K |
| 85025 |
|
1,571 |
1,265 |
$14K |
| 59025 |
|
57 |
43 |
$9K |
| 80048 |
|
674 |
509 |
$9K |
| 96361 |
|
276 |
157 |
$9K |
| 36415 |
|
1,550 |
1,253 |
$6K |
| 71046 |
|
353 |
326 |
$6K |
| 87651 |
|
126 |
114 |
$5K |
| 74177 |
|
44 |
40 |
$5K |
| 83880 |
|
240 |
192 |
$4K |
| 93005 |
|
484 |
407 |
$4K |
| 83735 |
|
626 |
518 |
$4K |
| 71045 |
|
523 |
456 |
$4K |
| 96375 |
|
128 |
97 |
$4K |
| 86901 |
|
185 |
154 |
$4K |
| 96374 |
|
277 |
252 |
$4K |
| 84484 |
|
400 |
333 |
$3K |
| 85027 |
|
608 |
483 |
$3K |
| T1015 |
Clinic service |
326 |
257 |
$2K |
| 74176 |
|
46 |
43 |
$2K |
| 97162 |
|
31 |
27 |
$2K |
| 81001 |
|
931 |
777 |
$2K |
| 81025 |
|
264 |
233 |
$2K |
| 94760 |
|
99 |
69 |
$2K |
| 83690 |
|
254 |
227 |
$2K |
| 87088 |
|
272 |
239 |
$1K |
| 87086 |
|
272 |
239 |
$1K |
| 77067 |
|
28 |
26 |
$1K |
| 82248 |
|
309 |
252 |
$1K |
| 82550 |
|
249 |
222 |
$1K |
| 82247 |
|
192 |
158 |
$1K |
| 85730 |
|
251 |
237 |
$1K |
| 86900 |
|
185 |
154 |
$1K |
| 85610 |
|
281 |
259 |
$893.70 |
| J0696 |
Ceftriaxone sodium injection |
312 |
228 |
$876.06 |
| 94640 |
|
144 |
123 |
$866.14 |
| 96372 |
|
212 |
134 |
$849.59 |
| J2405 |
Ondansetron hcl injection |
503 |
390 |
$803.84 |
| 87040 |
|
111 |
81 |
$783.19 |
| 84075 |
|
153 |
133 |
$777.38 |
| J1100 |
Dexamethasone sodium phos |
262 |
219 |
$740.80 |
| 83605 |
|
111 |
97 |
$736.56 |
| 87210 |
|
152 |
112 |
$729.88 |
| 82040 |
|
150 |
130 |
$729.86 |
| 84460 |
|
155 |
135 |
$709.56 |
| 84155 |
|
156 |
135 |
$537.17 |
| J1885 |
Ketorolac tromethamine inj |
341 |
290 |
$436.33 |
| 86850 |
|
154 |
131 |
$404.85 |
| 84443 |
|
37 |
34 |
$402.53 |
| 96376 |
|
34 |
13 |
$360.00 |
| 96360 |
|
31 |
28 |
$327.62 |
| 81003 |
|
235 |
200 |
$319.84 |
| 77063 |
|
28 |
26 |
$298.25 |
| 82565 |
|
39 |
38 |
$205.82 |
| 74018 |
|
16 |
12 |
$198.07 |
| 87077 |
|
32 |
28 |
$172.95 |
| 80061 |
|
14 |
14 |
$164.35 |
| 85055 |
|
14 |
13 |
$130.00 |
| 85007 |
|
92 |
82 |
$123.00 |
| 82947 |
|
23 |
12 |
$119.20 |
| J0780 |
Prochlorperazine injection |
125 |
102 |
$91.54 |
| J1170 |
Hydromorphone injection |
243 |
185 |
$81.47 |
| 82150 |
|
14 |
12 |
$64.82 |
| J1650 |
Inj enoxaparin sodium |
38 |
26 |
$62.40 |
| 87186 |
|
15 |
13 |
$62.01 |
| 84439 |
|
16 |
13 |
$52.74 |
| 86140 |
|
14 |
12 |
$44.34 |
| J2270 |
Morphine sulfate injection |
36 |
26 |
$6.30 |
| J2704 |
Inj, propofol, 10 mg |
101 |
91 |
$4.63 |
| J7030 |
Normal saline solution infus |
507 |
353 |
$0.58 |
| J7120 |
Ringers lactate infusion |
249 |
200 |
$0.28 |
| J7050 |
Normal saline solution infus |
97 |
55 |
$0.16 |
| J2250 |
Inj midazolam hydrochloride |
27 |
24 |
$0.00 |
| J3010 |
Fentanyl citrate injection |
73 |
66 |
$0.00 |
| 99285 |
|
13 |
13 |
$0.00 |
| 99284 |
|
34 |
32 |
$0.00 |
| J1171 |
Inj, hydromorphone, 0.1 mg |
37 |
23 |
$0.00 |