| Code | Description | Claims | Beneficiaries | Total Paid |
| G0463 |
Hospital outpt clinic visit |
51,391 |
37,408 |
$509K |
| 74177 |
|
3,341 |
3,128 |
$434K |
| G0480 |
Drug test def 1-7 classes |
4,375 |
3,779 |
$297K |
| 97110 |
|
7,906 |
2,647 |
$254K |
| 87502 |
|
2,317 |
2,265 |
$192K |
| 80053 |
|
34,550 |
28,338 |
$192K |
| 80307 |
|
4,514 |
3,959 |
$183K |
| 85025 |
|
35,950 |
28,656 |
$153K |
| 99284 |
|
3,961 |
3,372 |
$138K |
| 99285 |
|
3,163 |
2,658 |
$130K |
| 99283 |
|
3,050 |
2,664 |
$104K |
| 70450 |
|
2,738 |
2,556 |
$95K |
| 84443 |
|
10,049 |
9,125 |
$84K |
| U0002 |
Covid-19 lab test non-cdc |
2,142 |
2,073 |
$77K |
| 71275 |
|
671 |
653 |
$75K |
| 97140 |
|
3,147 |
1,190 |
$74K |
| 78452 |
|
434 |
420 |
$67K |
| 77067 |
|
1,711 |
1,665 |
$67K |
| 69436 |
|
112 |
111 |
$65K |
| 72125 |
|
1,061 |
1,025 |
$55K |
| 36415 |
|
36,501 |
29,696 |
$54K |
| 71260 |
|
724 |
703 |
$53K |
| J0585 |
Injection,onabotulinumtoxina |
200 |
130 |
$43K |
| 71046 |
|
4,171 |
3,968 |
$43K |
| 76705 |
|
1,007 |
986 |
$42K |
| J0475 |
Baclofen 10 mg injection |
104 |
104 |
$41K |
| 97162 |
|
876 |
848 |
$40K |
| 84484 |
|
7,238 |
5,393 |
$38K |
| 74176 |
|
578 |
553 |
$38K |
| J2785 |
Regadenoson injection |
428 |
412 |
$36K |
| 78815 |
|
70 |
69 |
$36K |
| 82306 |
|
2,425 |
2,291 |
$35K |
| 83690 |
|
7,408 |
6,501 |
$35K |
| 76830 |
|
558 |
549 |
$33K |
| C9803 |
Hopd covid-19 spec collect |
2,811 |
2,603 |
$32K |
| 76856 |
|
593 |
586 |
$32K |
| 87491 |
|
984 |
958 |
$31K |
| 84439 |
|
6,369 |
5,779 |
$31K |
| 87591 |
|
983 |
958 |
$31K |
| 71045 |
|
6,192 |
5,561 |
$29K |
| 96361 |
|
2,494 |
1,803 |
$28K |
| 99212 |
|
1,813 |
1,553 |
$27K |
| 83880 |
|
1,933 |
1,724 |
$25K |
| 87633 |
|
72 |
68 |
$24K |
| 97112 |
|
751 |
374 |
$23K |
| 87086 |
|
5,451 |
4,856 |
$23K |
| U0003 |
Cov-19 amp prb hgh thruput |
677 |
626 |
$21K |
| 96374 |
|
3,888 |
2,931 |
$21K |
| 84703 |
|
2,897 |
2,724 |
$20K |
| 93306 |
|
348 |
334 |
$20K |
| 76801 |
|
347 |
319 |
$19K |
| 99282 |
|
740 |
665 |
$19K |
| 81025 |
|
2,811 |
2,652 |
$19K |
| 80048 |
|
5,321 |
4,004 |
$18K |
| A9552 |
F18 fdg |
142 |
140 |
$17K |
| 96375 |
|
2,765 |
1,877 |
$17K |
| 87634 |
|
193 |
192 |
$15K |
| 76642 |
|
442 |
435 |
$15K |
| 80061 |
|
5,245 |
4,972 |
$15K |
| 97161 |
|
311 |
298 |
$15K |
| 81001 |
|
7,377 |
6,345 |
$14K |
| 81003 |
|
10,251 |
9,179 |
$14K |
| J2704 |
Inj, propofol, 10 mg |
4,261 |
3,721 |
$14K |
| 84702 |
|
906 |
726 |
$14K |
| 76700 |
|
244 |
239 |
$14K |
| 83036 |
|
7,024 |
6,580 |
$13K |
| 42820 |
|
25 |
25 |
$13K |
| 76817 |
|
282 |
260 |
$13K |
| 70553 |
|
85 |
81 |
$13K |
| 72148 |
|
133 |
131 |
$13K |
| 87651 |
|
346 |
343 |
$13K |
| J7120 |
Ringers lactate infusion |
3,449 |
3,120 |
$12K |
| 85610 |
|
7,373 |
5,651 |
$12K |
| 70551 |
|
117 |
116 |
$11K |
| 96372 |
|
3,097 |
2,298 |
$11K |
| 83605 |
|
1,499 |
1,252 |
$11K |
| 85027 |
|
3,049 |
2,653 |
$10K |
| 83735 |
|
3,619 |
2,718 |
$10K |
| 30140 |
|
13 |
13 |
$10K |
| 82728 |
|
1,601 |
1,490 |
$10K |
| 87077 |
|
2,129 |
1,944 |
$10K |
| 96365 |
|
305 |
220 |
$9K |
| 82248 |
|
2,089 |
1,896 |
$9K |
| 93005 |
|
5,985 |
4,774 |
$9K |
| 41899 |
|
12 |
12 |
$9K |
| 99211 |
|
666 |
512 |
$9K |
| 87186 |
|
1,641 |
1,519 |
$9K |
| 73630 |
|
1,024 |
969 |
$9K |
| 73610 |
|
840 |
784 |
$8K |
| J2405 |
Ondansetron hcl injection |
8,895 |
7,492 |
$8K |
| J3010 |
Fentanyl citrate injection |
5,699 |
4,802 |
$8K |
| J1100 |
Dexamethasone sodium phos |
3,932 |
3,431 |
$8K |
| 71250 |
|
214 |
209 |
$8K |
| 73130 |
|
575 |
557 |
$8K |
| 72100 |
|
691 |
679 |
$8K |
| 87040 |
|
962 |
562 |
$8K |
| 85730 |
|
1,867 |
1,731 |
$7K |
| 85379 |
|
988 |
947 |
$7K |
| J1170 |
Hydromorphone injection |
3,577 |
2,850 |
$7K |
| 86850 |
|
1,006 |
936 |
$7K |
| 74018 |
|
604 |
559 |
$7K |
| 82550 |
|
1,579 |
1,470 |
$7K |
| 86140 |
|
1,917 |
1,667 |
$6K |
| 73030 |
|
762 |
716 |
$6K |
| 97116 |
|
336 |
167 |
$6K |
| 73562 |
|
495 |
483 |
$6K |
| 87880 |
|
539 |
524 |
$6K |
| 82607 |
|
1,721 |
1,582 |
$6K |
| J7030 |
Normal saline solution infus |
5,168 |
4,034 |
$6K |
| 62370 |
|
145 |
144 |
$5K |
| 96360 |
|
340 |
318 |
$5K |
| 84466 |
|
848 |
791 |
$5K |
| 87430 |
|
400 |
394 |
$5K |
| 86900 |
|
1,328 |
1,229 |
$5K |
| A9500 |
Tc99m sestamibi |
142 |
137 |
$5K |
| 73502 |
|
644 |
617 |
$5K |
| J2370 |
Phenylephrine hcl injection |
996 |
942 |
$5K |
| 86901 |
|
1,326 |
1,228 |
$4K |
| 87210 |
|
928 |
475 |
$4K |
| 90715 |
|
226 |
222 |
$4K |
| 87798 |
|
112 |
104 |
$4K |
| J1885 |
Ketorolac tromethamine inj |
5,408 |
4,477 |
$4K |
| J0690 |
Cefazolin sodium injection |
1,269 |
1,103 |
$4K |
| 82553 |
|
625 |
572 |
$4K |
| J0780 |
Prochlorperazine injection |
556 |
514 |
$4K |
| 87070 |
|
655 |
593 |
$4K |
| 20610 |
|
372 |
313 |
$4K |
| 73564 |
|
516 |
502 |
$4K |
| 77066 |
Tomosynthesis, mammo |
53 |
53 |
$4K |
| 73110 |
|
285 |
273 |
$4K |
| A9502 |
Tc99m tetrofosmin |
56 |
56 |
$3K |
| 87280 |
|
228 |
224 |
$3K |
| 82803 |
|
171 |
162 |
$3K |
| 87081 |
|
425 |
415 |
$3K |
| 87420 |
|
220 |
217 |
$3K |
| 97163 |
|
54 |
54 |
$3K |
| 90834 |
|
565 |
322 |
$3K |
| 83540 |
|
1,026 |
943 |
$3K |
| 11042 |
|
171 |
93 |
$3K |
| 97530 |
|
228 |
120 |
$3K |
| A9575 |
Inj gadoterate meglumi 0.1ml |
215 |
206 |
$2K |
| J2795 |
Ropivacaine hcl injection |
198 |
186 |
$2K |
| 85652 |
|
1,789 |
1,607 |
$2K |
| 82570 |
|
1,821 |
1,605 |
$2K |
| G0008 |
Admin influenza virus vac |
1,528 |
1,496 |
$2K |
| G0378 |
Hospital observation per hr |
145 |
115 |
$2K |
| 84100 |
|
656 |
516 |
$2K |
| J2710 |
Neostigmine methylslfte inj |
727 |
700 |
$2K |
| 76536 |
|
30 |
30 |
$2K |
| 87486 |
|
72 |
68 |
$2K |
| 87581 |
|
72 |
68 |
$2K |
| J2550 |
Promethazine hcl injection |
953 |
823 |
$2K |
| 70496 |
|
14 |
13 |
$2K |
| 87481 |
|
13 |
12 |
$2K |
| 82784 |
|
133 |
129 |
$2K |
| 87635 |
|
433 |
385 |
$2K |
| 73560 |
|
181 |
174 |
$2K |
| 90686 |
|
954 |
931 |
$2K |
| 94640 |
|
758 |
425 |
$2K |
| 70498 |
|
12 |
12 |
$2K |
| 93296 |
|
403 |
381 |
$2K |
| 72040 |
|
175 |
165 |
$2K |
| 84156 |
|
535 |
466 |
$1K |
| 90837 |
|
217 |
135 |
$1K |
| 82746 |
|
328 |
306 |
$1K |
| 77080 |
|
151 |
151 |
$1K |
| 82043 |
|
962 |
921 |
$1K |
| 70486 |
|
24 |
24 |
$1K |
| 77065 |
Tomosynthesis, mammo |
29 |
26 |
$1K |
| 87340 |
|
49 |
49 |
$1K |
| 83615 |
|
258 |
196 |
$1K |
| J1200 |
Diphenhydramine hcl injectio |
1,878 |
1,589 |
$1K |
| 87046 |
|
43 |
41 |
$1K |
| 73590 |
|
139 |
129 |
$1K |
| J2270 |
Morphine sulfate injection |
536 |
425 |
$1K |
| 99213 |
|
12 |
12 |
$1K |
| 97014 |
|
81 |
34 |
$1K |
| 87205 |
|
371 |
327 |
$1K |
| 73090 |
|
58 |
49 |
$1K |
| 87511 |
|
13 |
12 |
$960.00 |
| 97166 |
|
12 |
12 |
$943.92 |
| 87427 |
|
82 |
41 |
$932.40 |
| J7050 |
Normal saline solution infus |
761 |
521 |
$891.30 |
| J0696 |
Ceftriaxone sodium injection |
401 |
218 |
$852.11 |
| 90471 |
|
69 |
65 |
$835.78 |
| 84132 |
|
175 |
159 |
$827.94 |
| 51798 |
|
24 |
19 |
$814.66 |
| 86787 |
|
24 |
24 |
$800.52 |
| 87015 |
|
182 |
163 |
$791.26 |
| G0009 |
Admin pneumococcal vaccine |
203 |
195 |
$786.21 |
| 97165 |
|
12 |
12 |
$785.46 |
| J2060 |
Lorazepam injection |
1,111 |
975 |
$724.63 |
| J1644 |
Inj heparin sodium per 1000u |
540 |
332 |
$707.47 |
| 82247 |
|
120 |
80 |
$672.18 |
| 76770 |
|
14 |
13 |
$658.89 |
| J7040 |
Normal saline solution infus |
636 |
519 |
$653.29 |
| 82565 |
|
126 |
120 |
$602.61 |
| 84481 |
|
27 |
27 |
$581.65 |
| 90662 |
|
273 |
269 |
$576.62 |
| 80164 |
|
75 |
64 |
$536.77 |
| 74220 |
|
12 |
12 |
$536.50 |
| 87661 |
|
13 |
12 |
$522.00 |
| 11720 |
|
531 |
521 |
$521.96 |
| 86780 |
|
24 |
24 |
$515.27 |
| J3301 |
Triamcinolone acet inj nos |
194 |
184 |
$514.92 |
| 90732 |
|
32 |
30 |
$477.52 |
| 77063 |
|
1,192 |
1,171 |
$454.56 |
| 73080 |
|
38 |
38 |
$450.33 |
| 86762 |
|
12 |
12 |
$448.00 |
| Q3014 |
Telehealth facility fee |
348 |
252 |
$443.80 |
| J2765 |
Metoclopramide hcl injection |
568 |
518 |
$438.36 |
| J1630 |
Haloperidol injection |
508 |
444 |
$438.33 |
| 83970 |
|
16 |
15 |
$434.15 |
| 86039 |
|
52 |
48 |
$433.02 |
| 83516 |
|
30 |
24 |
$426.91 |
| 82950 |
|
14 |
14 |
$422.50 |
| 85007 |
|
130 |
113 |
$411.86 |
| J2250 |
Inj midazolam hydrochloride |
1,136 |
1,006 |
$402.00 |
| 87624 |
|
13 |
13 |
$389.97 |
| 87045 |
|
42 |
41 |
$377.64 |
| 86803 |
|
57 |
53 |
$302.73 |
| 93017 |
|
25 |
24 |
$280.14 |
| 87269 |
|
24 |
24 |
$266.40 |
| 87272 |
|
24 |
24 |
$266.40 |
| 97802 |
|
118 |
116 |
$261.59 |
| P9612 |
Catheterize for urine spec |
146 |
142 |
$235.33 |
| 90460 |
|
12 |
12 |
$195.00 |
| 85300 |
|
26 |
26 |
$188.01 |
| 82140 |
|
20 |
13 |
$178.09 |
| J1815 |
Insulin injection |
102 |
58 |
$175.51 |
| 72070 |
|
15 |
14 |
$173.38 |
| J8540 |
Oral dexamethasone |
143 |
134 |
$169.14 |
| J3370 |
Vancomycin hcl injection |
32 |
24 |
$157.89 |
| J8597 |
Antiemetic drug oral nos |
1,534 |
1,437 |
$149.86 |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
1,874 |
1,690 |
$144.34 |
| 93299 |
|
177 |
176 |
$138.95 |
| 85018 |
|
50 |
45 |
$135.10 |
| 73620 |
|
13 |
13 |
$117.69 |
| J7512 |
Prednisone ir or dr oral 1mg |
165 |
134 |
$107.39 |
| 87075 |
|
19 |
14 |
$106.15 |
| 88305 |
|
110 |
93 |
$102.62 |
| 87177 |
|
12 |
12 |
$89.01 |
| G0279 |
Tomosynthesis, mammo |
41 |
41 |
$88.85 |
| G8980 |
Mobility d/c status |
122 |
108 |
$87.50 |
| G8979 |
Mobility goal status |
240 |
162 |
$87.50 |
| G8978 |
Mobility current status |
178 |
155 |
$87.50 |
| J0330 |
Succinycholine chloride inj |
52 |
52 |
$82.90 |
| 84153 |
|
15 |
15 |
$79.17 |
| 84550 |
|
24 |
24 |
$74.76 |
| 94060 |
|
13 |
13 |
$71.43 |
| 87804 |
|
99 |
57 |
$68.76 |
| J1040 |
Methylprednisolone 80 mg inj |
25 |
25 |
$68.59 |
| 80177 |
|
15 |
13 |
$65.44 |
| U0005 |
Infec agen detec ampli probe |
329 |
289 |
$61.23 |
| J0171 |
Adrenalin epinephrine inject |
18 |
15 |
$60.30 |
| 73552 |
|
13 |
13 |
$57.48 |
| 90791 |
|
41 |
40 |
$53.89 |
| 94726 |
|
27 |
26 |
$49.43 |
| G0103 |
Psa screening |
12 |
12 |
$48.22 |
| 97010 |
|
1,061 |
432 |
$40.00 |
| 86431 |
|
13 |
12 |
$35.00 |
| 80178 |
|
14 |
12 |
$29.36 |
| U0001 |
2019-ncov diagnostic p |
25 |
24 |
$22.22 |
| 93922 |
|
14 |
13 |
$20.86 |
| 91320 |
|
16 |
16 |
$19.42 |
| J1171 |
Inj, hydromorphone, 0.1 mg |
20 |
15 |
$11.15 |
| J3420 |
Vitamin b12 injection |
39 |
37 |
$9.88 |
| P9603 |
One-way allow prorated miles |
382 |
295 |
$7.99 |
| 96376 |
|
122 |
97 |
$7.68 |
| 90653 |
|
40 |
39 |
$5.26 |
| 82962 |
|
101 |
99 |
$4.51 |
| A9270 |
Non-covered item or service |
52 |
25 |
$0.00 |
| A9585 |
Gadobutrol injection |
133 |
130 |
$0.00 |
| G8988 |
Self care goal status |
13 |
12 |
$0.00 |
| G8987 |
Self care current status |
12 |
12 |
$0.00 |
| 90694 |
|
121 |
119 |
$0.00 |
| 90656 |
|
48 |
48 |
$0.00 |
| 90480 |
|
16 |
16 |
$0.00 |
| 97597 |
|
17 |
14 |
$0.00 |
| T1013 |
Sign lang/oral interpreter |
486 |
216 |
$0.00 |
| 94729 |
|
51 |
50 |
$0.00 |
| P9604 |
One-way allow prorated trip |
18 |
12 |
$0.00 |
| 0124A |
|
41 |
40 |
$0.00 |
| 11721 |
|
18 |
15 |
$0.00 |