| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 69436 |
|
73 |
62 |
$55K |
| 43239 |
|
358 |
352 |
$41K |
| 45380 |
|
92 |
87 |
$18K |
| 66984 |
|
13 |
12 |
$10K |
| 45385 |
|
28 |
24 |
$6K |
| 45378 |
|
12 |
12 |
$2K |
| 43235 |
|
12 |
12 |
$1K |
| 88305 |
|
757 |
556 |
$1K |
| 90686 |
|
41 |
41 |
$1K |
| 88342 |
|
251 |
235 |
$1K |
| G0008 |
Admin influenza virus vac |
36 |
36 |
$350.20 |
| 81025 |
|
287 |
254 |
$206.00 |
| J2704 |
Inj, propofol, 10 mg |
2,645 |
2,348 |
$96.90 |
| 82962 |
|
191 |
137 |
$37.08 |
| J1100 |
Dexamethasone sodium phos |
1,535 |
1,501 |
$21.30 |
| J3010 |
Fentanyl citrate injection |
1,545 |
1,350 |
$10.74 |
| J0690 |
Cefazolin sodium injection |
574 |
554 |
$7.16 |
| J2405 |
Ondansetron hcl injection |
1,751 |
1,706 |
$5.43 |
| J2250 |
Inj midazolam hydrochloride |
1,229 |
1,199 |
$0.98 |
| J1885 |
Ketorolac tromethamine inj |
486 |
469 |
$0.78 |
| S0020 |
Injection, bupivicaine hydro |
28 |
27 |
$0.00 |
| J0131 |
Inj, acetaminophen (nos) |
13 |
12 |
$0.00 |
| J2795 |
Ropivacaine hcl injection |
19 |
14 |
$0.00 |
| J1170 |
Hydromorphone injection |
14 |
14 |
$0.00 |
| J2270 |
Morphine sulfate injection |
12 |
12 |
$0.00 |