| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
19 |
15 |
$27K |
| T1015 |
Clinic visit/encounter, all-inclusive |
63 |
38 |
$12K |
| J7120 |
Ringers lactate infusion, up to 1000 cc |
327 |
190 |
$0.00 |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
239 |
174 |
$0.00 |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
35 |
27 |
$0.00 |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
238 |
169 |
$0.00 |
| J7999 |
Compounded drug, not otherwise classified |
164 |
98 |
$0.00 |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
290 |
157 |
$0.00 |
| J2704 |
Injection, propofol, 10 mg |
216 |
154 |
$0.00 |
| J3490 |
Unclassified drugs |
329 |
148 |
$0.00 |
| J0131 |
Injection, acetaminophen, not otherwise specified,10 mg |
192 |
135 |
$0.00 |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
252 |
182 |
$0.00 |