| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 29848 |
|
12 |
12 |
$7K |
| 87426 |
|
150 |
149 |
$7K |
| 62323 |
|
15 |
15 |
$6K |
| 99283 |
|
18 |
17 |
$3K |
| 99211 |
|
133 |
132 |
$3K |
| 80061 |
|
100 |
100 |
$1K |
| 80053 |
|
123 |
123 |
$1K |
| 85025 |
|
124 |
124 |
$856.84 |
| 36415 |
|
122 |
122 |
$522.18 |
| 82306 |
|
16 |
16 |
$421.28 |
| J3010 |
Fentanyl citrate injection |
329 |
328 |
$220.12 |
| 72100 |
|
12 |
12 |
$162.14 |
| 83036 |
|
13 |
13 |
$112.32 |
| 86900 |
|
24 |
24 |
$78.14 |
| J2405 |
Ondansetron hcl injection |
284 |
283 |
$25.15 |
| J1030 |
Methylprednisolone 40 mg inj |
132 |
131 |
$7.00 |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
57 |
57 |
$0.12 |
| J7120 |
Ringers lactate infusion |
188 |
188 |
$0.00 |
| J3490 |
Drugs unclassified injection |
120 |
119 |
$0.00 |
| J1100 |
Dexamethasone sodium phos |
177 |
176 |
$0.00 |
| J2001 |
Lidocaine injection |
620 |
618 |
$0.00 |
| J2250 |
Inj midazolam hydrochloride |
336 |
336 |
$0.00 |
| J2795 |
Ropivacaine hcl injection |
244 |
244 |
$0.00 |
| J1040 |
Methylprednisolone 80 mg inj |
16 |
16 |
$0.00 |
| J0690 |
Cefazolin sodium injection |
41 |
41 |
$0.00 |