| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
|
301 |
294 |
$134K |
| D0120 |
|
184 |
182 |
$69K |
| D1110 |
|
39 |
39 |
$23K |
| 43239 |
|
12 |
12 |
$2K |
| J2704 |
Inj, propofol, 10 mg |
1,377 |
1,286 |
$48.64 |
| J7120 |
Ringers lactate infusion |
728 |
700 |
$3.32 |
| J2405 |
Ondansetron hcl injection |
784 |
726 |
$0.04 |
| J2250 |
Inj midazolam hydrochloride |
532 |
517 |
$0.03 |
| J7040 |
Normal saline solution infus |
258 |
255 |
$0.00 |
| J0134 |
Inj acetaminophen -fresenius |
86 |
82 |
$0.00 |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
42 |
38 |
$0.00 |
| J0665 |
Inj, bupivacaine, nos, 0.5mg |
110 |
96 |
$0.00 |
| J1100 |
Dexamethasone sodium phos |
497 |
490 |
$0.00 |
| 88305 |
|
67 |
67 |
$0.00 |
| J2001 |
Lidocaine injection |
644 |
628 |
$0.00 |
| J1885 |
Ketorolac tromethamine inj |
240 |
237 |
$0.00 |
| J3490 |
Drugs unclassified injection |
271 |
174 |
$0.00 |
| J3010 |
Fentanyl citrate injection |
488 |
406 |
$0.00 |
| J0131 |
Inj, acetaminophen (nos) |
236 |
235 |
$0.00 |
| D7310 |
|
13 |
12 |
$0.00 |
| J2003 |
Inj, lidocaine hcl, 1 mg |
28 |
26 |
$0.00 |
| J0330 |
Succinycholine chloride inj |
13 |
13 |
$0.00 |