| Code | Description | Claims | Beneficiaries | Total Paid |
| 0450 |
|
180,921 |
157,485 |
$2.16M |
| 99199 |
|
29,252 |
24,184 |
$1.57M |
| 74177 |
|
14,149 |
13,872 |
$793K |
| Z7502 |
|
17,538 |
17,215 |
$642K |
| 96374 |
|
36,081 |
33,273 |
$533K |
| Z9725 |
|
12,122 |
12,073 |
$521K |
| 0202U |
|
6,259 |
6,184 |
$484K |
| 70450 |
|
10,326 |
10,089 |
$477K |
| 93000 |
|
33,824 |
29,180 |
$334K |
| 85025 |
|
116,277 |
105,836 |
$297K |
| 87633 |
|
2,150 |
2,125 |
$253K |
| 96375 |
|
25,933 |
23,112 |
$232K |
| 96372 |
|
28,929 |
25,727 |
$208K |
| 80048 |
|
75,023 |
68,732 |
$207K |
| 71046 |
|
29,396 |
28,576 |
$204K |
| 0360 |
|
10,604 |
9,671 |
$194K |
| U0003 |
Cov-19 amp prb hgh thruput |
13,493 |
13,065 |
$188K |
| 96361 |
|
19,141 |
17,387 |
$156K |
| 93005 |
|
22,695 |
19,969 |
$140K |
| 80053 |
|
42,343 |
38,639 |
$138K |
| 99285 |
|
2,316 |
2,137 |
$138K |
| 72125 |
|
2,572 |
2,534 |
$137K |
| C9803 |
Hopd covid-19 spec collect |
25,710 |
24,817 |
$133K |
| 70551 |
|
1,108 |
1,099 |
$130K |
| 84484 |
|
37,890 |
30,433 |
$125K |
| V2632 |
Post chmbr intraocular lens |
1,873 |
1,638 |
$124K |
| 74176 |
|
3,987 |
3,921 |
$119K |
| 80076 |
|
44,503 |
41,966 |
$109K |
| 71045 |
|
13,574 |
13,008 |
$107K |
| 99284 |
|
3,155 |
3,000 |
$103K |
| 76705 |
|
6,254 |
6,117 |
$96K |
| 71275 |
|
1,996 |
1,942 |
$96K |
| 96360 |
|
5,844 |
5,684 |
$90K |
| 96365 |
|
5,708 |
5,004 |
$90K |
| 66984 |
|
1,813 |
1,589 |
$86K |
| 76856 |
|
6,239 |
6,147 |
$84K |
| 88305 |
|
8,609 |
8,365 |
$81K |
| 76801 |
|
6,792 |
6,196 |
$75K |
| 93971 |
|
2,805 |
2,742 |
$75K |
| 93306 |
|
6,323 |
5,977 |
$74K |
| 81001 |
|
69,232 |
65,448 |
$74K |
| 99283 |
|
3,933 |
3,663 |
$74K |
| 83880 |
|
9,677 |
9,089 |
$72K |
| 76830 |
|
5,182 |
5,115 |
$70K |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
19,068 |
18,591 |
$68K |
| P9016 |
Rbc leukocytes reduced |
1,382 |
1,240 |
$67K |
| 83690 |
|
28,706 |
27,104 |
$65K |
| 99281 |
|
1,819 |
1,592 |
$63K |
| 76817 |
|
4,811 |
4,384 |
$59K |
| 87502 |
|
3,410 |
3,117 |
$57K |
| 80306 |
|
10,067 |
9,472 |
$57K |
| 76815 |
|
10,501 |
6,239 |
$56K |
| 83605 |
|
14,833 |
13,109 |
$51K |
| 83520 |
|
7,533 |
6,143 |
$51K |
| 0241U |
|
2,765 |
2,740 |
$50K |
| 70553 |
|
410 |
406 |
$48K |
| 0160 |
|
4,248 |
3,734 |
$47K |
| 87086 |
|
27,970 |
26,772 |
$44K |
| 93975 |
|
791 |
781 |
$37K |
| 0710 |
|
10,452 |
10,096 |
$36K |
| 78452 |
|
972 |
965 |
$35K |
| 80047 |
|
16,157 |
15,474 |
$35K |
| 93010 |
|
22,354 |
20,169 |
$34K |
| 0250 |
|
29,857 |
21,875 |
$34K |
| 94640 |
|
6,510 |
5,570 |
$34K |
| 80307 |
|
2,214 |
2,152 |
$33K |
| 87040 |
|
9,238 |
5,531 |
$33K |
| 84443 |
|
10,829 |
10,631 |
$32K |
| 70486 |
|
753 |
750 |
$32K |
| J2405 |
Ondansetron hcl injection |
24,083 |
21,864 |
$32K |
| 72148 |
|
532 |
526 |
$31K |
| 90715 |
|
3,659 |
3,647 |
$31K |
| J1885 |
Ketorolac tromethamine inj |
19,142 |
18,226 |
$30K |
| 87635 |
|
5,500 |
5,321 |
$29K |
| U0005 |
Infec agen detec ampli probe |
7,619 |
7,374 |
$29K |
| 43239 |
|
3,673 |
3,647 |
$29K |
| 76700 |
|
2,813 |
2,782 |
$28K |
| 85027 |
|
19,072 |
17,459 |
$28K |
| 70496 |
|
586 |
581 |
$28K |
| J2270 |
Morphine sulfate injection |
12,131 |
10,543 |
$27K |
| J2704 |
Inj, propofol, 10 mg |
11,510 |
10,673 |
$24K |
| 84702 |
|
11,443 |
10,354 |
$24K |
| 83735 |
|
11,589 |
9,588 |
$24K |
| 71260 |
|
411 |
410 |
$24K |
| J7030 |
Normal saline solution infus |
12,683 |
12,110 |
$24K |
| 96366 |
|
2,422 |
2,134 |
$24K |
| 0750 |
|
439 |
399 |
$23K |
| A9500 |
Tc99m sestamibi |
941 |
923 |
$23K |
| 88342 |
|
2,694 |
2,649 |
$23K |
| 81025 |
|
14,968 |
14,395 |
$22K |
| J2785 |
Regadenoson injection |
698 |
697 |
$22K |
| 76770 |
|
1,301 |
1,265 |
$22K |
| T1999 |
Noc retail items andsupplies |
2,281 |
2,031 |
$21K |
| 84703 |
|
17,738 |
17,211 |
$21K |
| 86850 |
|
7,541 |
7,163 |
$19K |
| 0270 |
|
57,916 |
40,397 |
$18K |
| 73562 |
|
3,043 |
3,010 |
$18K |
| 73630 |
|
3,024 |
2,990 |
$18K |
| 85379 |
|
5,695 |
5,535 |
$17K |
| 73030 |
|
2,709 |
2,632 |
$17K |
| 93970 |
|
533 |
528 |
$17K |
| 99282 |
|
1,367 |
1,269 |
$17K |
| 36430 |
|
1,641 |
1,383 |
$17K |
| U0002 |
Covid-19 lab test non-cdc |
1,672 |
1,642 |
$16K |
| J1200 |
Diphenhydramine hcl injectio |
10,313 |
9,629 |
$16K |
| 73610 |
|
2,402 |
2,369 |
$16K |
| 82805 |
|
1,923 |
1,789 |
$15K |
| 72100 |
|
2,053 |
2,041 |
$15K |
| J1170 |
Hydromorphone injection |
7,239 |
5,730 |
$15K |
| J3010 |
Fentanyl citrate injection |
10,960 |
10,163 |
$14K |
| 86901 |
|
12,661 |
11,667 |
$14K |
| 85610 |
|
14,066 |
13,035 |
$14K |
| 87591 |
|
4,813 |
4,734 |
$13K |
| 72131 |
|
339 |
336 |
$13K |
| 73130 |
|
2,332 |
2,304 |
$13K |
| J0780 |
Prochlorperazine injection |
3,832 |
3,678 |
$13K |
| 70498 |
|
539 |
534 |
$13K |
| 87491 |
|
4,776 |
4,696 |
$13K |
| 70491 |
|
211 |
211 |
$12K |
| G0480 |
Drug test def 1-7 classes |
509 |
501 |
$12K |
| J2250 |
Inj midazolam hydrochloride |
9,353 |
8,813 |
$12K |
| A9575 |
Inj gadoterate meglumi 0.1ml |
1,148 |
1,129 |
$12K |
| J2765 |
Metoclopramide hcl injection |
6,869 |
6,404 |
$11K |
| 76870 |
|
715 |
697 |
$11K |
| 11042 |
|
6,573 |
3,119 |
$10K |
| 77067 |
|
2,443 |
2,437 |
$10K |
| 11043 |
|
2,488 |
1,296 |
$10K |
| 86900 |
|
12,692 |
11,690 |
$10K |
| 73502 |
|
712 |
705 |
$10K |
| 97530 |
|
2,413 |
1,476 |
$10K |
| 36415 |
|
10,455 |
8,985 |
$9K |
| J0696 |
Ceftriaxone sodium injection |
7,472 |
6,841 |
$9K |
| 99291 |
|
245 |
241 |
$9K |
| 82150 |
|
4,050 |
3,869 |
$9K |
| 59025 |
|
14,730 |
5,090 |
$9K |
| J1100 |
Dexamethasone sodium phos |
5,178 |
4,839 |
$8K |
| 74246 |
|
805 |
802 |
$8K |
| J2060 |
Lorazepam injection |
4,606 |
4,001 |
$8K |
| 45378 |
|
593 |
589 |
$8K |
| 73110 |
|
1,430 |
1,416 |
$7K |
| 82248 |
|
4,651 |
4,491 |
$7K |
| 0324 |
|
442 |
432 |
$7K |
| 87210 |
|
5,512 |
5,351 |
$7K |
| 71250 |
|
190 |
188 |
$7K |
| 87088 |
|
5,804 |
5,691 |
$7K |
| 85018 |
|
11,492 |
10,952 |
$7K |
| J1815 |
Insulin injection |
3,186 |
1,621 |
$6K |
| J0561 |
Penicillin g benzathine inj |
71 |
67 |
$6K |
| 93017 |
|
809 |
807 |
$6K |
| 84439 |
|
4,554 |
4,492 |
$6K |
| 85014 |
|
11,068 |
10,610 |
$6K |
| 87186 |
|
7,624 |
7,477 |
$6K |
| 85730 |
|
4,483 |
4,267 |
$6K |
| Z7610 |
|
2,175 |
1,496 |
$6K |
| J2930 |
Methylprednisolone injection |
1,871 |
1,682 |
$6K |
| 83036 |
|
6,914 |
6,839 |
$6K |
| 82731 |
|
1,273 |
1,238 |
$6K |
| 0762 |
|
103 |
59 |
$6K |
| 82803 |
|
804 |
785 |
$6K |
| 86923 |
|
1,726 |
1,502 |
$5K |
| 97110 |
|
1,291 |
878 |
$5K |
| Q3014 |
Telehealth facility fee |
544 |
448 |
$5K |
| 73590 |
|
1,037 |
1,024 |
$5K |
| 74174 |
|
113 |
113 |
$5K |
| 80061 |
|
6,127 |
6,046 |
$5K |
| 82140 |
|
1,344 |
1,249 |
$5K |
| 84100 |
|
3,961 |
3,187 |
$5K |
| 76816 |
|
859 |
830 |
$5K |
| 73700 |
|
220 |
217 |
$5K |
| 81003 |
|
6,085 |
5,932 |
$5K |
| J1750 |
Inj iron dextran |
277 |
266 |
$5K |
| J7120 |
Ringers lactate infusion |
2,604 |
2,474 |
$5K |
| 0121 |
|
20 |
18 |
$5K |
| 82550 |
|
2,037 |
1,919 |
$4K |
| 45380 |
|
742 |
734 |
$4K |
| C1776 |
Joint device (implantable) |
26 |
26 |
$4K |
| 86703 |
|
2,519 |
2,510 |
$4K |
| 87081 |
|
4,256 |
4,220 |
$4K |
| J2359 |
Inj. olanzapine, 0.5mg |
268 |
213 |
$4K |
| 73080 |
|
633 |
628 |
$4K |
| 0761 |
|
1,216 |
691 |
$4K |
| 94760 |
|
1,912 |
1,707 |
$4K |
| 87880 |
|
1,487 |
1,457 |
$3K |
| 76642 |
|
869 |
854 |
$3K |
| 87070 |
|
3,174 |
3,008 |
$3K |
| 85007 |
|
3,440 |
3,249 |
$3K |
| 0403 |
|
31 |
31 |
$3K |
| 72040 |
|
337 |
334 |
$3K |
| 87147 |
|
2,387 |
2,338 |
$3K |
| 0760 |
|
2,081 |
1,433 |
$3K |
| Q9966 |
Locm 200-299mg/ml iodine,1ml |
220 |
218 |
$2K |
| 93458 |
|
44 |
44 |
$2K |
| 87400 |
|
1,030 |
397 |
$2K |
| M0243 |
Casirivi and imdevi inj |
121 |
120 |
$2K |
| 82306 |
|
2,734 |
2,712 |
$2K |
| 45385 |
|
262 |
261 |
$2K |
| J3475 |
Inj magnesium sulfate |
1,105 |
1,020 |
$2K |
| J2560 |
Phenobarbital sodium inj |
93 |
83 |
$2K |
| J1630 |
Haloperidol injection |
2,252 |
1,989 |
$2K |
| J0360 |
Hydralazine hcl injection |
724 |
612 |
$2K |
| 72141 |
|
39 |
39 |
$2K |
| 74018 |
|
436 |
422 |
$2K |
| 73090 |
|
394 |
388 |
$2K |
| 82607 |
|
2,521 |
2,486 |
$2K |
| 80074 |
|
235 |
230 |
$2K |
| J1644 |
Inj heparin sodium per 1000u |
1,062 |
622 |
$2K |
| 86140 |
|
1,843 |
1,660 |
$2K |
| 87641 |
|
241 |
235 |
$2K |
| 84550 |
|
1,908 |
1,768 |
$2K |
| 82746 |
|
1,378 |
1,350 |
$2K |
| 88304 |
|
729 |
725 |
$2K |
| J3370 |
Vancomycin hcl injection |
355 |
267 |
$2K |
| 88360 |
|
344 |
336 |
$2K |
| 77066 |
Tomosynthesis, mammo |
393 |
389 |
$2K |
| 76805 |
|
494 |
491 |
$2K |
| 82728 |
|
2,186 |
2,118 |
$2K |
| 87077 |
|
2,257 |
2,223 |
$2K |
| G0378 |
Hospital observation per hr |
36 |
30 |
$2K |
| 94644 |
|
347 |
284 |
$2K |
| 85652 |
|
3,011 |
2,824 |
$2K |
| 80055 |
|
511 |
507 |
$1K |
| 86780 |
|
629 |
613 |
$1K |
| J0690 |
Cefazolin sodium injection |
572 |
543 |
$1K |
| 71020 |
|
613 |
306 |
$1K |
| 82010 |
|
476 |
462 |
$1K |
| 90792 |
|
54 |
49 |
$1K |
| 84466 |
|
1,854 |
1,808 |
$1K |
| 81223 |
|
42 |
42 |
$1K |
| 72072 |
|
169 |
169 |
$1K |
| 86480 |
|
840 |
836 |
$1K |
| 71101 |
|
113 |
112 |
$1K |
| 77063 |
|
1,346 |
1,343 |
$1K |
| J3105 |
Terbutaline sulfate inj |
656 |
612 |
$1K |
| 72050 |
|
123 |
120 |
$1K |
| J1040 |
Methylprednisolone 80 mg inj |
159 |
159 |
$1K |
| 84156 |
|
1,427 |
1,214 |
$1K |
| 11046 |
|
25 |
12 |
$1K |
| 84132 |
|
1,371 |
1,270 |
$1K |
| J1953 |
Levetiracetam injection |
289 |
263 |
$1K |
| J2710 |
Neostigmine methylslfte inj |
26 |
15 |
$1K |
| 76536 |
|
264 |
261 |
$995.12 |
| 86592 |
|
1,787 |
1,756 |
$949.13 |
| J1650 |
Inj enoxaparin sodium |
597 |
368 |
$945.70 |
| 74183 |
|
66 |
65 |
$938.70 |
| J1940 |
Furosemide injection |
554 |
420 |
$910.15 |
| 86803 |
|
1,536 |
1,526 |
$907.84 |
| 84295 |
|
1,162 |
1,093 |
$904.80 |
| C1729 |
Cath, drainage |
72 |
52 |
$847.76 |
| 86308 |
|
522 |
518 |
$830.34 |
| J3490 |
Drugs unclassified injection |
6,115 |
5,234 |
$809.41 |
| 80051 |
|
530 |
513 |
$806.20 |
| 83540 |
|
1,936 |
1,879 |
$762.66 |
| 73552 |
|
132 |
131 |
$755.06 |
| 97116 |
|
270 |
223 |
$750.25 |
| 97161 |
|
2,033 |
1,997 |
$738.47 |
| 82565 |
|
751 |
707 |
$732.68 |
| 96376 |
|
1,784 |
1,495 |
$722.27 |
| G0463 |
Hospital outpt clinic visit |
77 |
68 |
$682.81 |
| J7050 |
Normal saline solution infus |
850 |
760 |
$673.75 |
| 82310 |
|
568 |
552 |
$641.39 |
| 12001 |
|
226 |
225 |
$622.48 |
| C1769 |
Guide wire |
127 |
122 |
$606.90 |
| 92610 |
|
63 |
63 |
$602.91 |
| 82570 |
|
630 |
584 |
$551.98 |
| A9579 |
Gad-base mr contrast nos,1ml |
223 |
222 |
$548.90 |
| 72170 |
|
192 |
191 |
$535.46 |
| 87205 |
|
596 |
547 |
$498.76 |
| 96367 |
|
66 |
62 |
$496.80 |
| 90471 |
|
580 |
521 |
$492.79 |
| 92650 |
|
19 |
19 |
$487.92 |
| J7040 |
Normal saline solution infus |
406 |
375 |
$474.17 |
| 72128 |
|
27 |
26 |
$467.32 |
| 73560 |
|
91 |
91 |
$464.54 |
| J2919 |
Inj, methylpred sod succ 5mg |
222 |
199 |
$456.60 |
| 0301 |
|
164 |
161 |
$443.21 |
| 0320 |
|
19 |
18 |
$439.69 |
| 47563 |
|
12 |
12 |
$385.08 |
| 77062 |
|
283 |
283 |
$354.53 |
| J0697 |
Sterile cefuroxime injection |
391 |
343 |
$318.85 |
| 84480 |
|
58 |
58 |
$316.15 |
| 86403 |
|
183 |
100 |
$316.04 |
| 73564 |
|
40 |
39 |
$309.60 |
| J2175 |
Meperidine hydrochl /100 mg |
76 |
72 |
$306.46 |
| 73140 |
|
68 |
66 |
$296.81 |
| 99232 |
|
29 |
29 |
$290.88 |
| 87340 |
|
166 |
166 |
$289.22 |
| 86376 |
|
134 |
133 |
$278.09 |
| 10060 |
|
505 |
489 |
$265.03 |
| J1171 |
Inj, hydromorphone, 0.1 mg |
120 |
99 |
$255.85 |
| A9270 |
Non-covered item or service |
567 |
267 |
$248.98 |
| G0475 |
Hiv combination assay |
278 |
278 |
$234.06 |
| 73060 |
|
60 |
59 |
$231.08 |
| 87045 |
|
128 |
126 |
$226.71 |
| 85460 |
|
88 |
86 |
$225.40 |
| 12011 |
|
12 |
12 |
$216.81 |
| J3480 |
Inj potassium chloride |
215 |
168 |
$214.33 |
| 0258 |
|
948 |
900 |
$208.18 |
| 86696 |
|
776 |
704 |
$187.12 |
| 86695 |
|
776 |
704 |
$187.12 |
| J0665 |
Inj, bupivacaine, nos, 0.5mg |
294 |
280 |
$186.23 |
| 93798 |
|
341 |
99 |
$182.47 |
| 74300 |
|
25 |
25 |
$170.53 |
| 77080 |
|
108 |
107 |
$166.67 |
| 86141 |
|
64 |
64 |
$162.81 |
| J2795 |
Ropivacaine hcl injection |
28 |
26 |
$159.10 |
| G0472 |
Hep c screen high risk/other |
211 |
211 |
$155.73 |
| 87493 |
|
24 |
24 |
$154.65 |
| 84481 |
|
200 |
199 |
$137.81 |
| 86800 |
|
50 |
50 |
$136.99 |
| 82950 |
|
508 |
507 |
$121.84 |
| J2470 |
Inj pantoprazole sodium 40mg |
74 |
69 |
$119.22 |
| 71010 |
|
80 |
34 |
$119.16 |
| 83970 |
|
50 |
50 |
$117.25 |
| 87015 |
|
123 |
119 |
$111.05 |
| 74240 |
|
14 |
14 |
$104.30 |
| 97165 |
|
192 |
190 |
$99.94 |
| 87046 |
|
241 |
138 |
$99.36 |
| C1894 |
Intro/sheath, non-laser |
87 |
86 |
$94.80 |
| 84153 |
|
25 |
25 |
$94.36 |
| J3301 |
Triamcinolone acet inj nos |
48 |
43 |
$92.90 |
| 76937 |
|
15 |
13 |
$87.82 |
| J1836 |
Inj, metronidazole, 10 mg |
37 |
30 |
$87.14 |
| 82043 |
|
387 |
387 |
$85.76 |
| 77065 |
Tomosynthesis, mammo |
28 |
28 |
$84.30 |
| 86870 |
|
12 |
12 |
$81.75 |
| 93880 |
|
43 |
38 |
$70.48 |
| 80069 |
|
16 |
13 |
$68.16 |
| 82947 |
|
227 |
225 |
$64.49 |
| J7512 |
Prednisone ir or dr oral 1mg |
684 |
485 |
$64.47 |
| 87185 |
|
419 |
415 |
$57.58 |
| 74241 |
|
12 |
12 |
$56.58 |
| 82330 |
|
15 |
12 |
$54.72 |
| 73620 |
|
13 |
13 |
$48.39 |
| A9537 |
Tc99m mebrofenin |
12 |
12 |
$47.63 |
| 94729 |
|
65 |
65 |
$46.42 |
| 94060 |
|
101 |
100 |
$43.40 |
| 94726 |
|
61 |
61 |
$42.55 |
| 82247 |
|
159 |
127 |
$34.36 |
| 86038 |
|
140 |
136 |
$32.96 |
| 86762 |
|
20 |
20 |
$30.72 |
| 43235 |
|
12 |
12 |
$30.24 |
| J1920 |
Inj, labetalol hcl, 5mg |
19 |
13 |
$27.53 |
| J0295 |
Ampicillin sulbactam 1.5 gm |
117 |
97 |
$26.55 |
| 12002 |
|
58 |
58 |
$24.00 |
| 90686 |
|
13 |
13 |
$23.49 |
| J0171 |
Adrenalin epinephrine inject |
41 |
39 |
$23.02 |
| J8597 |
Antiemetic drug oral nos |
648 |
548 |
$21.93 |
| J0456 |
Azithromycin |
15 |
13 |
$21.00 |
| 82375 |
|
105 |
105 |
$18.37 |
| J0702 |
Betamethasone acet&sod phosp |
20 |
13 |
$18.24 |
| 86235 |
|
13 |
13 |
$14.40 |
| 82810 |
|
46 |
46 |
$12.80 |
| 86431 |
|
37 |
37 |
$12.00 |
| 82977 |
|
12 |
12 |
$10.10 |
| 99070 |
|
21 |
13 |
$8.79 |
| 85046 |
|
13 |
13 |
$7.94 |
| 77061 |
|
25 |
25 |
$7.86 |
| 81050 |
|
15 |
12 |
$4.14 |
| C9113 |
Inj pantoprazole sodium, via |
120 |
84 |
$0.00 |
| 0730 |
|
17 |
17 |
$0.00 |
| 93308 |
|
28 |
26 |
$0.00 |
| 0370R |
|
42 |
40 |
$0.00 |
| 29125 |
|
28 |
27 |
$0.00 |
| 0272 |
|
39 |
39 |
$0.00 |
| 93325 |
|
97 |
80 |
$0.00 |
| C1887 |
Catheter, guiding |
26 |
25 |
$0.00 |
| 0302 |
|
18 |
18 |
$0.00 |
| 83721 |
|
97 |
96 |
$0.00 |
| 0272R |
|
29 |
27 |
$0.00 |
| 0424 |
|
13 |
13 |
$0.00 |
| 84425 |
|
12 |
12 |
$0.00 |
| 0300 |
|
37 |
37 |
$0.00 |
| 99001 |
|
72 |
72 |
$0.00 |
| 29515 |
|
14 |
14 |
$0.00 |
| 0710R |
|
29 |
27 |
$0.00 |
| 84146 |
|
26 |
26 |
$0.00 |
| 83655 |
|
24 |
24 |
$0.00 |
| J1245 |
Dipyridamole injection |
17 |
17 |
$0.00 |
| 93321 |
|
13 |
12 |
$0.00 |
| 83695 |
|
12 |
12 |
$0.00 |
| A4649 |
Surgical supplies |
17 |
15 |
$0.00 |
| 27447 |
|
27 |
27 |
$0.00 |
| 36600 |
|
17 |
17 |
$0.00 |
| 0260 |
|
22 |
22 |
$0.00 |
| 0122 |
|
13 |
12 |
$0.00 |
| 84207 |
|
12 |
12 |
$0.00 |
| Q0162 |
Ondansetron oral |
200 |
191 |
$0.00 |
| 11045 |
|
95 |
65 |
$0.00 |
| 15275 |
|
60 |
27 |
$0.00 |
| 0250R |
|
42 |
40 |
$0.00 |
| 0352 |
|
12 |
12 |
$0.00 |
| 0306 |
|
22 |
22 |
$0.00 |
| 0255 |
|
13 |
13 |
$0.00 |
| 0305 |
|
37 |
37 |
$0.00 |
| 0420 |
|
13 |
13 |
$0.00 |
| 0307 |
|
18 |
18 |
$0.00 |
| J3411 |
Thiamine hcl 100 mg |
15 |
12 |
$0.00 |