| Code | Description | Claims | Beneficiaries | Total Paid |
| A0429 |
Bls-emergency |
5,944 |
3,312 |
$335K |
| G0378 |
Hospital observation per hr |
258 |
176 |
$81K |
| 99285 |
|
3,883 |
3,088 |
$44K |
| 74176 |
|
2,647 |
2,440 |
$17K |
| 96376 |
|
2,691 |
1,592 |
$17K |
| 70450 |
|
3,549 |
3,189 |
$16K |
| 99284 |
|
1,284 |
1,048 |
$15K |
| 96374 |
|
6,159 |
5,037 |
$11K |
| 71045 |
|
6,832 |
5,829 |
$10K |
| 99283 |
|
714 |
661 |
$9K |
| 0450 |
|
11,449 |
9,668 |
$9K |
| 72125 |
|
1,356 |
1,245 |
$8K |
| 93005 |
|
9,110 |
7,501 |
$7K |
| 96375 |
|
5,218 |
3,758 |
$6K |
| 74177 |
|
747 |
699 |
$6K |
| 85025 |
|
15,247 |
11,461 |
$4K |
| 80053 |
|
8,331 |
6,883 |
$4K |
| 80307 |
|
2,904 |
2,441 |
$4K |
| 36415 |
|
2,265 |
1,180 |
$4K |
| J3490 |
Drugs unclassified injection |
17,670 |
5,231 |
$3K |
| 96361 |
|
2,324 |
1,655 |
$3K |
| 71275 |
|
441 |
393 |
$3K |
| 87635 |
|
1,325 |
1,115 |
$3K |
| 71046 |
|
1,600 |
1,540 |
$3K |
| 71250 |
|
219 |
204 |
$3K |
| A9585 |
Gadobutrol injection |
672 |
637 |
$3K |
| 84484 |
|
6,682 |
4,982 |
$2K |
| 0241U |
|
100 |
100 |
$2K |
| 96365 |
|
1,057 |
864 |
$2K |
| 83880 |
|
3,411 |
2,839 |
$2K |
| 97140 |
|
1,204 |
444 |
$2K |
| 80048 |
|
6,713 |
4,976 |
$2K |
| 72148 |
|
511 |
496 |
$2K |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
2,695 |
2,450 |
$2K |
| 96372 |
|
2,614 |
1,704 |
$2K |
| 0250 |
|
3,880 |
1,560 |
$2K |
| 97110 |
|
2,942 |
907 |
$2K |
| 76641 |
|
997 |
985 |
$2K |
| 82553 |
|
4,028 |
3,205 |
$2K |
| 72141 |
|
287 |
273 |
$1K |
| 77066 |
Tomosynthesis, mammo |
407 |
407 |
$1K |
| 70553 |
|
103 |
100 |
$1K |
| 70551 |
|
178 |
166 |
$1K |
| 77065 |
Tomosynthesis, mammo |
388 |
379 |
$1K |
| 82550 |
|
4,522 |
3,544 |
$1K |
| 76705 |
|
791 |
742 |
$994.61 |
| 97530 |
|
1,809 |
661 |
$965.88 |
| 93306 |
|
107 |
86 |
$907.88 |
| 96366 |
|
279 |
154 |
$902.40 |
| 76856 |
|
1,490 |
1,427 |
$855.76 |
| J2405 |
Ondansetron hcl injection |
2,613 |
1,968 |
$795.13 |
| 76830 |
|
1,376 |
1,323 |
$792.10 |
| 73721 |
|
181 |
162 |
$789.98 |
| 88305 |
|
689 |
556 |
$784.42 |
| 97162 |
|
59 |
54 |
$718.78 |
| 83690 |
|
5,021 |
4,298 |
$716.66 |
| 84443 |
|
1,906 |
1,645 |
$701.07 |
| J1170 |
Hydromorphone injection |
1,309 |
838 |
$696.75 |
| C9399 |
Unclassified drugs or biolog |
17 |
17 |
$672.09 |
| 76770 |
|
180 |
170 |
$589.29 |
| 83735 |
|
3,242 |
2,315 |
$588.77 |
| A4216 |
Sterile water/saline, 10 ml |
169 |
80 |
$568.30 |
| 78452 |
|
44 |
25 |
$539.76 |
| 0270 |
|
6,374 |
2,502 |
$526.46 |
| 81001 |
|
4,499 |
3,982 |
$520.93 |
| 71260 |
|
63 |
58 |
$498.51 |
| 93971 |
|
216 |
202 |
$494.90 |
| 82947 |
|
2,017 |
1,139 |
$477.18 |
| 82077 |
|
19 |
12 |
$476.57 |
| 85610 |
|
4,331 |
3,574 |
$449.67 |
| 72131 |
|
60 |
52 |
$441.59 |
| 76815 |
|
1,535 |
841 |
$429.15 |
| 87086 |
|
2,517 |
2,237 |
$414.57 |
| 97112 |
|
701 |
194 |
$395.46 |
| 99153 |
Mod sedat endo service >5yrs |
17 |
13 |
$381.24 |
| 76811 |
|
225 |
225 |
$372.55 |
| J2785 |
Regadenoson injection |
37 |
24 |
$364.86 |
| 84145 |
|
824 |
627 |
$360.93 |
| 80047 |
|
1,457 |
1,269 |
$352.98 |
| 86900 |
|
1,674 |
1,414 |
$345.21 |
| 94760 |
|
1,475 |
738 |
$326.57 |
| 81003 |
|
4,902 |
4,307 |
$320.96 |
| 76700 |
|
471 |
467 |
$315.03 |
| 87040 |
|
1,021 |
718 |
$310.00 |
| A9500 |
Tc99m sestamibi |
45 |
26 |
$301.90 |
| 85730 |
|
2,646 |
2,252 |
$300.01 |
| 77067 |
|
1,682 |
1,681 |
$293.96 |
| 72100 |
|
574 |
554 |
$293.77 |
| 0360 |
|
187 |
135 |
$292.34 |
| 86901 |
|
1,677 |
1,415 |
$292.27 |
| 83605 |
|
1,388 |
1,094 |
$290.87 |
| 86850 |
|
1,188 |
1,032 |
$285.80 |
| J0131 |
Inj, acetaminophen (nos) |
42 |
38 |
$276.31 |
| 80076 |
|
1,462 |
1,238 |
$264.50 |
| 94640 |
|
746 |
430 |
$264.35 |
| 59025 |
|
797 |
241 |
$261.60 |
| 72146 |
|
15 |
13 |
$252.65 |
| 87804 |
|
1,023 |
847 |
$233.57 |
| 82150 |
|
1,346 |
1,225 |
$232.62 |
| 73030 |
|
393 |
366 |
$231.16 |
| 73630 |
|
361 |
342 |
$228.66 |
| 84703 |
|
2,721 |
2,492 |
$225.58 |
| U0003 |
Cov-19 amp prb hgh thruput |
143 |
139 |
$224.12 |
| 96360 |
|
196 |
182 |
$221.03 |
| 73562 |
|
306 |
291 |
$210.69 |
| 85379 |
|
818 |
743 |
$207.87 |
| 85027 |
|
935 |
727 |
$195.96 |
| J1885 |
Ketorolac tromethamine inj |
667 |
608 |
$190.15 |
| 90715 |
|
196 |
188 |
$184.95 |
| 73610 |
|
280 |
260 |
$178.74 |
| 84702 |
|
1,155 |
1,044 |
$176.88 |
| 84100 |
|
575 |
349 |
$170.29 |
| J3010 |
Fentanyl citrate injection |
536 |
404 |
$155.80 |
| J7030 |
Normal saline solution infus |
302 |
246 |
$141.01 |
| 93970 |
|
35 |
29 |
$127.53 |
| J2704 |
Inj, propofol, 10 mg |
590 |
443 |
$122.36 |
| 93017 |
|
63 |
42 |
$118.46 |
| J1100 |
Dexamethasone sodium phos |
126 |
111 |
$111.38 |
| 77063 |
|
1,765 |
1,765 |
$105.30 |
| 87081 |
|
689 |
555 |
$103.74 |
| 0258 |
|
1,820 |
989 |
$96.61 |
| 73130 |
|
135 |
127 |
$94.27 |
| J2270 |
Morphine sulfate injection |
362 |
267 |
$90.49 |
| J2250 |
Inj midazolam hydrochloride |
380 |
353 |
$78.62 |
| 87186 |
|
485 |
419 |
$76.45 |
| J0696 |
Ceftriaxone sodium injection |
377 |
302 |
$70.03 |
| 73110 |
|
40 |
40 |
$59.86 |
| J2001 |
Lidocaine injection |
216 |
200 |
$57.86 |
| 70486 |
|
52 |
51 |
$56.66 |
| 84439 |
|
150 |
133 |
$55.31 |
| 0710 |
|
305 |
260 |
$52.26 |
| J7050 |
Normal saline solution infus |
91 |
57 |
$48.13 |
| 77080 |
|
254 |
254 |
$44.58 |
| 87077 |
|
273 |
213 |
$41.73 |
| 86141 |
|
144 |
122 |
$40.46 |
| 90471 |
|
190 |
181 |
$37.89 |
| 73221 |
|
13 |
12 |
$33.82 |
| J2060 |
Lorazepam injection |
419 |
300 |
$32.29 |
| 94664 |
|
49 |
46 |
$28.80 |
| 81025 |
|
464 |
427 |
$28.73 |
| 96367 |
|
21 |
12 |
$27.10 |
| 76817 |
|
501 |
389 |
$26.35 |
| 83036 |
|
184 |
128 |
$26.13 |
| 85007 |
|
510 |
408 |
$19.16 |
| 74018 |
|
128 |
118 |
$17.80 |
| 80061 |
|
42 |
26 |
$17.16 |
| 86140 |
|
502 |
369 |
$16.97 |
| J1644 |
Inj heparin sodium per 1000u |
87 |
50 |
$16.44 |
| 97116 |
|
47 |
12 |
$16.31 |
| J0690 |
Cefazolin sodium injection |
73 |
60 |
$15.03 |
| 76805 |
|
92 |
89 |
$14.21 |
| 87430 |
|
25 |
24 |
$13.58 |
| 85652 |
|
456 |
373 |
$13.37 |
| 82728 |
|
31 |
26 |
$12.74 |
| 0637 |
|
1,947 |
1,006 |
$12.25 |
| 73590 |
|
12 |
12 |
$11.73 |
| J1200 |
Diphenhydramine hcl injectio |
98 |
81 |
$10.86 |
| J7120 |
Ringers lactate infusion |
30 |
25 |
$10.57 |
| 73502 |
|
16 |
16 |
$8.21 |
| A9270 |
Non-covered item or service |
4,152 |
948 |
$7.96 |
| J7512 |
Prednisone ir or dr oral 1mg |
108 |
51 |
$7.82 |
| 87205 |
|
107 |
95 |
$6.84 |
| 73564 |
|
28 |
27 |
$6.42 |
| 87070 |
|
43 |
37 |
$6.01 |
| A4217 |
Sterile water/saline, 500 ml |
24 |
24 |
$6.00 |
| 72040 |
|
13 |
13 |
$5.92 |
| 85014 |
|
75 |
68 |
$5.54 |
| G8979 |
Mobility goal status |
45 |
40 |
$4.15 |
| G8978 |
Mobility current status |
40 |
37 |
$3.98 |
| 87147 |
|
14 |
14 |
$3.13 |
| 43239 |
|
13 |
13 |
$2.45 |
| 82248 |
|
40 |
37 |
$1.46 |
| G1004 |
Cdsm ndsc |
2,517 |
1,702 |
$0.09 |
| 80050 |
|
68 |
50 |
$0.00 |
| U0005 |
Infec agen detec ampli probe |
71 |
71 |
$0.00 |
| 0324 |
|
173 |
152 |
$0.00 |
| G0202 |
Scr mammo bi incl cad |
90 |
90 |
$0.00 |
| 76801 |
|
76 |
72 |
$0.00 |
| 0761 |
|
284 |
237 |
$0.00 |
| 0420 |
|
188 |
31 |
$0.00 |
| 0301 |
|
1,269 |
281 |
$0.00 |
| 97010 |
|
618 |
102 |
$0.00 |
| 0610 |
|
36 |
32 |
$0.00 |
| 97139 |
|
189 |
27 |
$0.00 |
| 0307 |
|
117 |
98 |
$0.00 |
| 0305 |
|
211 |
110 |
$0.00 |
| J3535 |
Metered dose inhaler drug |
16 |
13 |
$0.00 |
| 0352 |
|
147 |
108 |
$0.00 |
| 0636 |
|
225 |
105 |
$0.00 |
| 0310 |
|
35 |
14 |
$0.00 |
| 0306 |
|
312 |
130 |
$0.00 |
| 76536 |
|
14 |
14 |
$0.00 |
| 0949 |
|
85 |
33 |
$0.00 |
| 0612 |
Calcium glucon (wg critical) |
46 |
32 |
$0.00 |
| 0350 |
|
33 |
25 |
$0.00 |
| 0401 |
|
68 |
35 |
$0.00 |
| 71020 |
|
52 |
52 |
$0.00 |
| G0500 |
Mod sedat endo service >5yrs |
63 |
57 |
$0.00 |
| 0762 |
|
580 |
540 |
$0.00 |
| 77062 |
|
346 |
345 |
$0.00 |
| J2550 |
Promethazine hcl injection |
16 |
12 |
$0.00 |
| 0300 |
|
720 |
264 |
$0.00 |
| 0160 |
|
128 |
123 |
$0.00 |
| 77061 |
|
114 |
111 |
$0.00 |
| 0351 |
|
85 |
65 |
$0.00 |
| 0302 |
|
70 |
36 |
$0.00 |
| 0760 |
|
101 |
84 |
$0.00 |
| 0272 |
|
569 |
286 |
$0.00 |
| 0361 |
|
26 |
15 |
$0.00 |
| 76813 |
|
46 |
45 |
$0.00 |
| 0403 |
|
92 |
46 |
$0.00 |
| 71010 |
|
93 |
91 |
$0.00 |
| 0278 |
|
38 |
16 |
$0.00 |
| 99199 |
|
53 |
42 |
$0.00 |
| G0204 |
Dx mammo incl cad bi |
13 |
13 |
$0.00 |
| 0320 |
|
174 |
122 |
$0.00 |
| 0402 |
|
249 |
147 |
$0.00 |
| 0460 |
|
29 |
16 |
$0.00 |
| 97799 |
|
182 |
26 |
$0.00 |