CCS Statewide CY2012 Fee for Service Expenditures by Claim Type and Diagnosis Duplicate CIN Count Claim Type Code Desc DX Group DX SubGroup Sum of Medi-Cal Reimbursement * Outpatient Supplementary V Codes Malignancies $336,035.96 * Inpatient Supplementary V Codes Malignancies $243,270.00 * Medical/Physician Supplementary V Codes Malignancies $32,860.82 * Pharmacy Supplementary V Codes Malignancies $29,705.50 * Inpatient Conditions in the Perinatal Period Other $141,413.13 11 Pharmacy Conditions in the Perinatal Period Other $2,552.80 14 Inpatient Digestive System Gastroesophageal Reflux $247,541.11 19 Inpatient Genitourinary System Renal Failure $852,703.10 21 Inpatient Complications of Pregnancy, Childbirth and Puerperium Other $1,316,894.46 22 Medical/Physician Conditions in the Perinatal Period Other $39,917.47 23 Pharmacy Digestive System Gastroesophageal Reflux $77,401.23 23 Pharmacy Complications of Pregnancy, Childbirth and Puerperium Other $41,630.24 25 Pharmacy Genitourinary System Renal Failure $185,529.68 27 Inpatient Mental Disorders Other $622,331.34 28 Outpatient Conditions in the Perinatal Period Other $26,427.29 31 Inpatient Respiratory System Asthma $559,657.29 31 Medical/Physician Digestive System Gastroesophageal Reflux $69,924.70 32 Inpatient Congenital Anomalies Diaphragmetic - Anomalies $2,838,418.73 33 Outpatient Genitourinary System Renal Failure $281,139.42 34 Medical/Physician Genitourinary System Renal Failure $123,477.28 36 Outpatient Digestive System Gastroesophageal Reflux $74,631.88 44 Outpatient Complications of Pregnancy, Childbirth and Puerperium Other $90,953.47 46 Medical/Physician Complications of Pregnancy, Childbirth and Puerperium Other $93,839.45 49 Pharmacy Supplementary E Codes Other $55,960.02 52 Pharmacy Congenital Anomalies Diaphragmetic - Anomalies $192,240.30 59 Inpatient Unknown Other $1,641,393.34 61 Inpatient Endoctrine, Nutritional and Metabolic, Immunity Pituitary Disorders $1,101,747.79 64 Inpatient Skin and Subcutaneous Tissue Other $1,968,894.05 70 Inpatient Endoctrine, Nutritional and Metabolic, Immunity Immune Disorders $6,181,182.56 70 Inpatient Nervous System and Sense Organs Ear, Nose, Throat $849,432.88 73 Inpatient Congenital Anomalies Biliary Atresca $3,339,030.41 73 Pharmacy Respiratory System Asthma $266,708.24 79 Medical/Physician Congenital Anomalies Diaphragmetic - Anomalies $378,721.34 81 Inpatient Digestive System Malocclusion $1,901,307.10 82 Outpatient Congenital Anomalies Diaphragmetic - Anomalies $365,412.65 82 Pharmacy Unknown Other $86,982.80 95 Medical/Physician Respiratory System Asthma $148,270.75 102 Inpatient Supplementary E Codes Other $2,503,676.68 108 Outpatient Respiratory System Asthma $537,707.86 115 Inpatient Neoplasms Other $10,595,092.59 120 Inpatient Congenital Anomalies Congenital Hydrocephalus $3,133,569.62 123 Outpatient Supplementary E Codes Other $74,830.03 127 Inpatient Blood and Blood-Forming Organs Coagulation Disorders $4,629,595.14 128 Pharmacy Mental Disorders Other $113,535.28 130 Inpatient Neoplasms Brain Tumors $10,120,946.01
136 Medical/Physician Supplementary E Codes Other $235,455.53 140 Inpatient Infectious Diseases Other $7,361,750.61 156 Inpatient Nervous System and Sense Organs Hydrocephalus $8,317,516.60 167 Inpatient Endoctrine, Nutritional and Metabolic, Immunity Thyroid Disorders $3,817,607.43 170 Medical/Physician Unknown Other $156,208.66 171 Inpatient Blood and Blood-Forming Organs Anemias $7,852,867.04 173 Inpatient Nervous System and Sense Organs Myopathies $10,769,622.42 177 Inpatient Congenital Anomalies Anomalies of Abdominal Wall $18,478,590.19 178 Medical/Physician Mental Disorders Other $141,126.61 182 Outpatient Unknown Other $137,657.05 189 Inpatient Nervous System and Sense Organs Degenerative Disease of CNS $9,783,616.96 189 Pharmacy Congenital Anomalies Biliary Atresca $1,431,416.92 192 Pharmacy Skin and Subcutaneous Tissue Other $929,972.68 196 Pharmacy Neoplasms Other $837,211.78 202 Pharmacy Nervous System and Sense Organs Ear, Nose, Throat $195,641.31 204 Medical/Physician Congenital Anomalies Biliary Atresca $845,527.74 206 Pharmacy Digestive System Malocclusion $130,589.55 208 Pharmacy Injury and Poisoning Head Injury/Skull Fracture $298,634.18 210 Outpatient Congenital Anomalies Biliary Atresca $901,231.74 219 Inpatient Supplementary V Codes Prematurity/Live Birth $7,240,478.61 224 Pharmacy Congenital Anomalies Anomalies of Abdominal Wall $1,192,441.03 226 Pharmacy Congenital Anomalies Congenital Hydrocephalus $697,421.93 227 Inpatient Neoplasms Benign Neoplasms $5,452,101.35 242 Pharmacy Blood and Blood-Forming Organs Anemias $1,631,086.31 246 Inpatient Blood and Blood-Forming Organs Other $8,906,324.44 249 Inpatient Congenital Anomalies Spina Bifida $5,657,113.83 254 Pharmacy Neoplasms Brain Tumors $2,003,498.88 255 Outpatient Mental Disorders Other $291,069.62 256 Inpatient Musculoskeletal System and Connective Tissue Scoliosis $9,058,435.61 268 Pharmacy Nervous System and Sense Organs Hydrocephalus $748,613.37 271 Inpatient Endoctrine, Nutritional and Metabolic, Immunity Cystic Fibrosis $17,955,386.74 272 Pharmacy Blood and Blood-Forming Organs Other $3,094,778.32 275 Pharmacy Supplementary V Codes Prematurity/Live Birth $210,144.35 316 Inpatient Nervous System and Sense Organs Hearing Loss $9,871,367.14 317 Medical/Physician Skin and Subcutaneous Tissue Other $485,284.43 327 Medical/Physician Neoplasms Other $1,295,754.92 329 Pharmacy Infectious Diseases Other $4,805,995.87 330 Pharmacy Endoctrine, Nutritional and Metabolic, Immunity Immune Disorders $8,645,554.38 339 Outpatient Neoplasms Other $1,817,742.16 343 Outpatient Skin and Subcutaneous Tissue Other $628,273.82 348 Medical/Physician Congenital Anomalies Anomalies of Abdominal Wall $2,371,945.78 350 Outpatient Congenital Anomalies Anomalies of Abdominal Wall $1,097,512.50 354 Medical/Physician Endoctrine, Nutritional and Metabolic, Immunity Immune Disorders $981,973.03 357 Inpatient Respiratory System Other $15,877,407.72 360 Inpatient Nervous System and Sense Organs Ophthalmology $20,357,634.06 382 Inpatient Endoctrine, Nutritional and Metabolic, Immunity Other $12,570,748.58
384 Pharmacy Neoplasms Benign Neoplasms $721,565.04 385 Outpatient Endoctrine, Nutritional and Metabolic, Immunity Immune Disorders $2,129,753.20 393 Pharmacy Respiratory System Respiratory Failure $2,146,183.95 398 Inpatient Injury and Poisoning Head Injury/Skull Fracture $7,889,714.35 399 Medical/Physician Digestive System Malocclusion $296,114.86 404 Medical/Physician Neoplasms Brain Tumors $2,349,032.97 413 Outpatient Neoplasms Brain Tumors $3,393,362.98 429 Pharmacy Musculoskeletal System and Connective Tissue Scoliosis $906,094.16 433 Inpatient Supplementary V Codes Other $25,026,055.00 440 Inpatient Respiratory System Respiratory Failure $24,868,388.56 442 Medical/Physician Congenital Anomalies Congenital Hydrocephalus $1,287,926.86 448 Outpatient Supplementary V Codes Prematurity/Live Birth $234,874.29 450 Outpatient Congenital Anomalies Congenital Hydrocephalus $1,659,293.64 452 Outpatient Infectious Diseases Other $1,085,245.97 460 Inpatient Blood and Blood-Forming Organs Hemoglobinopathies $15,214,184.58 460 Medical/Physician Infectious Diseases Other $902,099.27 492 Inpatient Genitourinary System Renal $13,406,942.45 492 Pharmacy Nervous System and Sense Organs Myopathies $1,805,274.92 504 Inpatient Symptoms Signs and Ill-Defined Conditions Other $14,363,972.51 524 Medical/Physician Nervous System and Sense Organs Hydrocephalus $1,678,287.98 531 Inpatient Genitourinary System Other $9,449,574.51 532 Pharmacy Respiratory System Other $2,392,153.59 532 Outpatient Nervous System and Sense Organs Hydrocephalus $1,942,256.72 534 Inpatient Circulatory System Other $19,843,593.21 540 Medical/Physician Blood and Blood-Forming Organs Anemias $1,139,731.06 548 Pharmacy Nervous System and Sense Organs Degenerative Disease of CNS $3,107,401.21 552 Outpatient Respiratory System Respiratory Failure $10,686,718.48 568 Pharmacy Congenital Anomalies Spina Bifida $1,212,677.74 571 Outpatient Blood and Blood-Forming Organs Anemias $3,154,169.88 577 Pharmacy Circulatory System Other $1,940,327.10 590 Medical/Physician Supplementary V Codes Prematurity/Live Birth $736,216.48 594 Inpatient Circulatory System Cardiac - Medical Conditions $23,593,668.60 601 Medical/Physician Respiratory System Respiratory Failure $4,898,885.41 623 Medical/Physician Injury and Poisoning Head Injury/Skull Fracture $1,132,728.75 626 Medical/Physician Blood and Blood-Forming Organs Other $1,015,686.53 627 Pharmacy Endoctrine, Nutritional and Metabolic, Immunity Cystic Fibrosis $24,562,106.13 640 Inpatient Supplementary V Codes Screening for developmental handicaps in $55,674,234.77 655 Outpatient Injury and Poisoning Head Injury/Skull Fracture $769,208.90 657 Medical/Physician Nervous System and Sense Organs Ear, Nose, Throat $550,284.64 666 Pharmacy Endoctrine, Nutritional and Metabolic, Immunity Pituitary Disorders $12,273,745.59 667 Medical/Physician Endoctrine, Nutritional and Metabolic, Immunity Cystic Fibrosis $3,500,981.28 677 Outpatient Endoctrine, Nutritional and Metabolic, Immunity Cystic Fibrosis $1,741,414.93 696 Outpatient Blood and Blood-Forming Organs Other $2,211,546.52 700 Pharmacy Genitourinary System Other $706,729.22 703 Inpatient Nervous System and Sense Organs Other $47,233,330.00 709 Inpatient Nervous System and Sense Organs Epilepsy $16,414,284.84
709 Outpatient Endoctrine, Nutritional and Metabolic, Immunity Pituitary Disorders $1,797,510.00 711 Outpatient Nervous System and Sense Organs Ear, Nose, Throat $612,518.94 729 Medical/Physician Endoctrine, Nutritional and Metabolic, Immunity Pituitary Disorders $861,788.10 739 Inpatient Digestive System Other $33,797,850.82 778 Pharmacy Blood and Blood-Forming Organs Hemoglobinopathies $8,012,758.73 786 Inpatient Congenital Anomalies Cleft Palate/Lip $10,105,646.17 806 Pharmacy Blood and Blood-Forming Organs Coagulation Disorders $129,225,464.41 811 Medical/Physician Respiratory System Other $2,414,767.97 830 Pharmacy Supplementary V Codes Screening for developmental handicaps in $970,281.40 837 Medical/Physician Nervous System and Sense Organs Degenerative Disease of CNS $6,153,933.19 838 Medical/Physician Congenital Anomalies Spina Bifida $6,429,813.26 849 Outpatient Congenital Anomalies Spina Bifida $5,049,328.82 865 Outpatient Respiratory System Other $4,350,527.34 898 Medical/Physician Nervous System and Sense Organs Myopathies $7,523,153.62 916 Inpatient Musculoskeletal System and Connective Tissue Other $25,991,507.52 926 Medical/Physician Blood and Blood-Forming Organs Coagulation Disorders $2,220,917.90 976 Outpatient Nervous System and Sense Organs Degenerative Disease of CNS $12,961,753.41 988 Outpatient Blood and Blood-Forming Organs Coagulation Disorders $27,041,778.57 989 Outpatient Nervous System and Sense Organs Myopathies $11,511,402.63 1025 Medical/Physician Neoplasms Benign Neoplasms $1,484,331.93 1075 Pharmacy Injury and Poisoning Fractures $875,321.05 1089 Outpatient Neoplasms Benign Neoplasms $1,547,757.06 1097 Pharmacy Genitourinary System Renal $9,069,337.48 1113 Pharmacy Supplementary V Codes Other $7,361,434.48 1117 Pharmacy Injury and Poisoning Other $2,016,182.66 1184 Outpatient Digestive System Malocclusion $639,317.93 1198 Pharmacy Digestive System Other $8,180,203.56 1203 Medical/Physician Circulatory System Other $3,160,361.86 1213 Medical/Physician Blood and Blood-Forming Organs Hemoglobinopathies $1,696,788.43 1245 Outpatient Blood and Blood-Forming Organs Hemoglobinopathies $3,345,430.01 1246 Outpatient Circulatory System Other $4,459,909.20 1358 Pharmacy Congenital Anomalies Cleft Palate/Lip $2,029,092.09 1415 Pharmacy Circulatory System Cardiac - Medical Conditions $7,286,070.94 1416 Medical/Physician Genitourinary System Renal $3,507,527.72 1475 Pharmacy Nervous System and Sense Organs Other $10,025,909.09 1483 Outpatient Genitourinary System Renal $8,066,766.23 1489 Pharmacy Symptoms Signs and Ill-Defined Conditions Other $6,179,306.96 1491 Inpatient Endoctrine, Nutritional and Metabolic, Immunity Diabetes $19,981,938.37 1533 Inpatient Neoplasms Malignancies $118,080,553.73 1647 Pharmacy Endoctrine, Nutritional and Metabolic, Immunity Other $17,013,402.18 1679 Inpatient Nervous System and Sense Organs Cerebral Palsy $70,900,516.72 1707 Outpatient Musculoskeletal System and Connective Tissue Scoliosis $2,688,069.37 1727 Pharmacy Nervous System and Sense Organs Ophthalmology $2,683,799.20 1770 Medical/Physician Supplementary V Codes Other $4,608,798.49 1789 Medical/Physician Supplementary V Codes Screening for developmental handicaps in $4,447,487.09 1804 Inpatient Injury and Poisoning Other $54,287,350.14
1834 Medical/Physician Digestive System Other $5,559,083.22 1853 Pharmacy Nervous System and Sense Organs Epilepsy $10,781,274.02 1853 Medical/Physician Musculoskeletal System and Connective Tissue Scoliosis $2,495,602.21 1860 Inpatient Injury and Poisoning Fractures $26,933,711.06 1892 Pharmacy Endoctrine, Nutritional and Metabolic, Immunity Thyroid Disorders $2,385,412.26 1905 Outpatient Digestive System Other $7,751,209.74 2016 Inpatient Congenital Anomalies Cardiac - Congenital Anomalies $85,851,866.53 2046 Pharmacy Musculoskeletal System and Connective Tissue Other $10,015,588.78 2065 Outpatient Supplementary V Codes Screening for developmental handicaps in $2,020,369.93 2139 Outpatient Supplementary V Codes Other $9,267,747.66 2183 Medical/Physician Nervous System and Sense Organs Epilepsy $4,768,171.77 2234 Medical/Physician Endoctrine, Nutritional and Metabolic, Immunity Other $3,691,993.58 2240 Medical/Physician Genitourinary System Other $2,125,029.49 2252 Inpatient Congenital Anomalies Other $65,502,136.37 2309 Outpatient Endoctrine, Nutritional and Metabolic, Immunity Other $13,353,222.51 2350 Outpatient Nervous System and Sense Organs Epilepsy $9,821,747.89 2417 Medical/Physician Nervous System and Sense Organs Other $11,558,668.85 2464 Outpatient Genitourinary System Other $2,335,685.03 2485 Medical/Physician Symptoms Signs and Ill-Defined Conditions Other $3,812,424.30 2606 Pharmacy Neoplasms Malignancies $14,947,636.09 2612 Outpatient Nervous System and Sense Organs Other $23,802,484.13 2725 Pharmacy Nervous System and Sense Organs Hearing Loss $4,268,671.71 2749 Outpatient Symptoms Signs and Ill-Defined Conditions Other $8,781,597.99 2811 Outpatient Circulatory System Cardiac - Medical Conditions $5,794,407.43 3133 Medical/Physician Circulatory System Cardiac - Medical Conditions $5,835,310.82 3342 Medical/Physician Injury and Poisoning Other $7,127,623.12 3477 Inpatient Conditions in the Perinatal Period Prematurity/Live Birth $193,501,660.76 3547 Outpatient Injury and Poisoning Other $7,631,469.57 3740 Medical/Physician Congenital Anomalies Cleft Palate/Lip $5,417,677.91 3863 Outpatient Endoctrine, Nutritional and Metabolic, Immunity Thyroid Disorders $2,831,415.14 3896 Medical/Physician Endoctrine, Nutritional and Metabolic, Immunity Thyroid Disorders $1,354,301.18 4094 Outpatient Congenital Anomalies Cleft Palate/Lip $6,465,040.76 4169 Medical/Physician Musculoskeletal System and Connective Tissue Other $5,959,612.71 4200 Pharmacy Conditions in the Perinatal Period Prematurity/Live Birth $6,539,973.66 4438 Outpatient Musculoskeletal System and Connective Tissue Other $10,678,585.23 4734 Pharmacy Congenital Anomalies Other $12,260,212.90 4953 Pharmacy Congenital Anomalies Cardiac - Congenital Anomalies $15,257,693.06 5043 Medical/Physician Injury and Poisoning Fractures $4,164,461.84 5200 Medical/Physician Neoplasms Malignancies $18,577,918.61 5219 Outpatient Nervous System and Sense Organs Ophthalmology $5,728,250.80 5258 Outpatient Neoplasms Malignancies $28,116,626.17 5497 Outpatient Injury and Poisoning Fractures $3,100,756.11 5984 Pharmacy Nervous System and Sense Organs Cerebral Palsy $30,610,431.14 6083 Medical/Physician Nervous System and Sense Organs Ophthalmology $5,812,546.52 6282 Outpatient Endoctrine, Nutritional and Metabolic, Immunity Diabetes $6,042,881.42 6303 Pharmacy Endoctrine, Nutritional and Metabolic, Immunity Diabetes $35,041,913.22
6560 Medical/Physician Endoctrine, Nutritional and Metabolic, Immunity Diabetes $7,616,525.14 7101 Medical/Physician Conditions in the Perinatal Period Prematurity/Live Birth $19,090,556.09 7224 Outpatient Conditions in the Perinatal Period Prematurity/Live Birth $14,914,470.10 8855 Medical/Physician Nervous System and Sense Organs Hearing Loss $8,777,194.32 9013 Medical/Physician Nervous System and Sense Organs Cerebral Palsy $43,376,390.20 10010 Outpatient Nervous System and Sense Organs Hearing Loss $17,448,183.57 10218 Outpatient Nervous System and Sense Organs Cerebral Palsy $91,278,071.89 10712 Outpatient Congenital Anomalies Cardiac - Congenital Anomalies $23,825,742.58 11929 Medical/Physician Congenital Anomalies Cardiac - Congenital Anomalies $25,483,563.04 12567 Medical/Physician Congenital Anomalies Other $26,369,376.73 13422 Outpatient Congenital Anomalies Other $30,180,450.66