| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 69436 |
|
275 |
265 |
$235K |
| 42820 |
|
39 |
39 |
$158K |
| 66984 |
|
79 |
52 |
$97K |
| U0003 |
Cov-19 amp prb hgh thruput |
891 |
852 |
$67K |
| 43239 |
|
80 |
79 |
$27K |
| C9803 |
Hopd covid-19 spec collect |
898 |
859 |
$22K |
| G0330 |
Facility svs dental rehab |
12 |
12 |
$14K |
| 41899 |
|
81 |
76 |
$10K |
| U0005 |
Infec agen detec ampli probe |
568 |
542 |
$8K |
| 62323 |
|
15 |
13 |
$8K |
| 64493 |
|
14 |
12 |
$6K |
| G0260 |
Inj for sacroiliac jt anesth |
16 |
14 |
$5K |
| 88305 |
|
195 |
106 |
$599.76 |
| 88300 |
|
249 |
133 |
$550.34 |
| J3490 |
Drugs unclassified injection |
781 |
438 |
$458.18 |
| J7342 |
Ciprofloxacin otic susp 6 mg |
52 |
51 |
$259.99 |
| J3301 |
Triamcinolone acet inj nos |
125 |
114 |
$0.00 |
| C1776 |
Joint device (implantable) |
17 |
17 |
$0.00 |
| V2632 |
Post chmbr intraocular lens |
79 |
52 |
$0.00 |
| 88342 |
|
28 |
27 |
$0.00 |
| J2704 |
Inj, propofol, 10 mg |
13 |
12 |
$0.00 |