| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J2704 |
Inj, propofol, 10 mg |
319 |
291 |
$19K |
| 88305 |
|
39 |
27 |
$801.68 |
| 82948 |
|
158 |
104 |
$265.72 |
| J3490 |
Drugs unclassified injection |
1,063 |
399 |
$157.27 |
| J1100 |
Dexamethasone sodium phos |
776 |
489 |
$87.95 |
| J3010 |
Fentanyl citrate injection |
1,134 |
874 |
$22.86 |
| J2175 |
Meperidine hydrochl /100 mg |
39 |
31 |
$16.78 |
| J2405 |
Ondansetron hcl injection |
672 |
508 |
$8.44 |
| J2250 |
Inj midazolam hydrochloride |
781 |
631 |
$4.42 |
| Q9966 |
Locm 200-299mg/ml iodine,1ml |
13 |
13 |
$0.00 |
| J3301 |
Triamcinolone acet inj nos |
33 |
26 |
$0.00 |
| J0690 |
Cefazolin sodium injection |
76 |
58 |
$0.00 |
| 36416 |
|
111 |
104 |
$0.00 |
| J1885 |
Ketorolac tromethamine inj |
38 |
26 |
$0.00 |
| J2003 |
Inj, lidocaine hcl, 1 mg |
40 |
31 |
$0.00 |