| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 43239 |
|
112 |
110 |
$14K |
| 45380 |
|
13 |
13 |
$4K |
| 88305 |
|
191 |
186 |
$722.25 |
| J2704 |
Inj, propofol, 10 mg |
4,206 |
3,872 |
$285.38 |
| J3010 |
Fentanyl citrate injection |
4,047 |
3,193 |
$102.08 |
| 82947 |
|
72 |
60 |
$68.00 |
| J2250 |
Inj midazolam hydrochloride |
2,808 |
2,611 |
$36.62 |
| J1100 |
Dexamethasone sodium phos |
2,736 |
2,608 |
$14.69 |
| J1644 |
Inj heparin sodium per 1000u |
982 |
730 |
$10.00 |
| J7040 |
Normal saline solution infus |
185 |
160 |
$8.33 |
| J2405 |
Ondansetron hcl injection |
3,247 |
3,020 |
$8.25 |
| J1630 |
Haloperidol injection |
1,209 |
1,152 |
$0.00 |
| J3490 |
Drugs unclassified injection |
1,137 |
1,001 |
$0.00 |
| J1170 |
Hydromorphone injection |
681 |
563 |
$0.00 |
| J0131 |
Inj, acetaminophen (nos) |
184 |
173 |
$0.00 |
| J0690 |
Cefazolin sodium injection |
1,455 |
1,089 |
$0.00 |
| J1885 |
Ketorolac tromethamine inj |
807 |
731 |
$0.00 |
| 36415 |
|
13 |
12 |
$0.00 |
| J7799 |
Non-inhalation drug for dme |
15 |
13 |
$0.00 |
| J7999 |
Compounded drug, noc |
25 |
24 |
$0.00 |
| J2710 |
Neostigmine methylslfte inj |
453 |
415 |
$0.00 |
| J7120 |
Ringers lactate infusion |
823 |
750 |
$0.00 |
| J7030 |
Normal saline solution infus |
333 |
308 |
$0.00 |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
397 |
373 |
$0.00 |
| J1596 |
Inj, glycopyrrolate, 0.1 mg |
277 |
273 |
$0.00 |
| J1171 |
Inj, hydromorphone, 0.1 mg |
43 |
37 |
$0.00 |
| J1200 |
Diphenhydramine hcl injectio |
56 |
55 |
$0.00 |
| J0665 |
Inj, bupivacaine, nos, 0.5mg |
424 |
420 |
$0.00 |
| J3475 |
Inj magnesium sulfate |
77 |
75 |
$0.00 |
| J3370 |
Vancomycin hcl injection |
76 |
51 |
$0.00 |
| J1650 |
Inj enoxaparin sodium |
24 |
14 |
$0.00 |