| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 66984 |
|
73 |
63 |
$177K |
| 43239 |
|
111 |
103 |
$161K |
| 45378 |
|
12 |
12 |
$21K |
| 45385 |
|
16 |
16 |
$19K |
| 87635 |
|
553 |
532 |
$8K |
| J3490 |
Drugs unclassified injection |
1,906 |
962 |
$6K |
| J2704 |
Inj, propofol, 10 mg |
1,107 |
1,077 |
$2K |
| C9803 |
Hopd covid-19 spec collect |
501 |
483 |
$688.11 |
| J3010 |
Fentanyl citrate injection |
766 |
654 |
$154.96 |
| 88305 |
|
54 |
54 |
$146.00 |
| J0690 |
Cefazolin sodium injection |
117 |
113 |
$61.92 |
| J2250 |
Inj midazolam hydrochloride |
549 |
535 |
$32.66 |
| J7120 |
Ringers lactate infusion |
799 |
754 |
$0.00 |
| J2405 |
Ondansetron hcl injection |
432 |
421 |
$0.00 |
| 01999 |
|
278 |
268 |
$0.00 |
| J1596 |
Inj, glycopyrrolate, 0.1 mg |
77 |
76 |
$0.00 |
| J1100 |
Dexamethasone sodium phos |
388 |
377 |
$0.00 |
| J0131 |
Inj, acetaminophen (nos) |
113 |
109 |
$0.00 |
| J1885 |
Ketorolac tromethamine inj |
112 |
111 |
$0.00 |
| J1170 |
Hydromorphone injection |
14 |
13 |
$0.00 |
| J2003 |
Inj, lidocaine hcl, 1 mg |
32 |
31 |
$0.00 |
| 85027 |
|
14 |
13 |
$0.00 |