| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J3490 |
Unclassified drugs |
590 |
355 |
$7K |
| J7120 |
Ringers lactate infusion, up to 1000 cc |
631 |
590 |
$761.59 |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
563 |
546 |
$61.13 |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
329 |
269 |
$28.78 |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
328 |
318 |
$25.50 |
| J0690 |
Injection, cefazolin sodium, 500 mg |
80 |
72 |
$25.46 |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
205 |
197 |
$23.89 |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
115 |
113 |
$3.22 |
| J2704 |
Injection, propofol, 10 mg |
250 |
248 |
$0.00 |
| J0131 |
Injection, acetaminophen, not otherwise specified,10 mg |
21 |
15 |
$0.00 |
| J7999 |
Compounded drug, not otherwise classified |
239 |
216 |
$0.00 |
| J7050 |
Infusion, normal saline solution, 250 cc |
39 |
38 |
$0.00 |
| J2795 |
Injection, ropivacaine hydrochloride, 1 mg |
41 |
32 |
$0.00 |
| J1596 |
Injection, glycopyrrolate, 0.1 mg |
88 |
88 |
$0.00 |
| J0136 |
Injection, acetaminophen (b braun), not therapeutically equivalent to j0131, 10 mg |
76 |
73 |
$0.00 |
| J0137 |
Injection, acetaminophen (hikma), not therapeutically equivalent to j0131, 10 mg |
129 |
121 |
$0.00 |