| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 69436 |
|
1,119 |
935 |
$270K |
| 42830 |
|
14 |
13 |
$7K |
| 42820 |
|
12 |
12 |
$5K |
| J1100 |
Dexamethasone sodium phos |
340 |
308 |
$2.91 |
| J2250 |
Inj midazolam hydrochloride |
816 |
640 |
$0.00 |
| J0883 |
Argatroban nonesrd use 1mg |
117 |
107 |
$0.00 |
| C1726 |
Cath, bal dil, non-vascular |
427 |
386 |
$0.00 |
| J0131 |
Inj, acetaminophen (nos) |
409 |
330 |
$0.00 |
| J3010 |
Fentanyl citrate injection |
243 |
201 |
$0.00 |
| Q9965 |
Locm 100-199mg/ml iodine,1ml |
44 |
40 |
$0.00 |
| J2175 |
Meperidine hydrochl /100 mg |
15 |
14 |
$0.00 |
| J2001 |
Lidocaine injection |
13 |
12 |
$0.00 |
| J2405 |
Ondansetron hcl injection |
347 |
310 |
$0.00 |
| C1713 |
Anchor/screw bn/bn,tis/bn |
20 |
12 |
$0.00 |