| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J2704 |
Inj, propofol, 10 mg |
2,018 |
1,518 |
$35.77 |
| J0690 |
Cefazolin sodium injection |
462 |
400 |
$13.18 |
| J1100 |
Dexamethasone sodium phos |
1,005 |
912 |
$13.00 |
| J3010 |
Fentanyl citrate injection |
1,217 |
1,031 |
$9.22 |
| 88305 |
|
41 |
39 |
$9.00 |
| J1885 |
Ketorolac tromethamine inj |
770 |
579 |
$4.57 |
| J2250 |
Inj midazolam hydrochloride |
1,173 |
1,066 |
$2.22 |
| J3490 |
Drugs unclassified injection |
1,719 |
1,208 |
$2.08 |
| J2405 |
Ondansetron hcl injection |
1,270 |
1,012 |
$1.64 |
| J1596 |
Inj, glycopyrrolate, 0.1 mg |
238 |
234 |
$0.00 |
| J0688 |
Inj cefazolin sodium, hikma |
60 |
58 |
$0.00 |
| J1171 |
Inj, hydromorphone, 0.1 mg |
25 |
18 |
$0.00 |
| J0665 |
Inj, bupivacaine, nos, 0.5mg |
112 |
112 |
$0.00 |
| J1170 |
Hydromorphone injection |
503 |
350 |
$0.00 |
| J0131 |
Inj, acetaminophen (nos) |
14 |
14 |
$0.00 |