139 / 208
Top 20 Procedures
MEMBER PAID
# OF CLAIMS
# OF
CLAIMANTS
PLAN PAID
PROCEDURE
CODE
$1,260.23
27
19
$72,719.13
MEDICAL/SURGICAL SUPPLIES:
OTHER IMPLANTS
0278
$3,135.33
115
2
$70,297.55
DIALYSIS PROCEDURE
90999
$199.49
4
3
$69,432.21
INTERMEDIATE CCU
0214
$6,713.63
227
146
$60,919.62
MEDICAL/SURGICAL SUPPLIES:
STERILE SUPPLIES
0272
$840.00
4
1
$59,621.50
USTEKINUMAB INJECTION
J3357
$2,840.24
9
7
$55,914.90
INTERMEDIATE ICU
0206
$6,738.98
144
105
$51,336.56
ANESTHESIA
0370
$1,248,250.35
41,056
$3,603,589.24
Remaining
Procedures
Page 38 of 41
Incurred: 2/1/2016 to 1/31/2017
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