| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 43239 |
|
899 |
875 |
$135K |
| 45380 |
|
587 |
570 |
$121K |
| 69436 |
|
91 |
80 |
$54K |
| 45385 |
|
105 |
103 |
$31K |
| 88305 |
|
2,632 |
2,519 |
$13K |
| 88342 |
|
603 |
589 |
$10K |
| J3490 |
Drugs unclassified injection |
4,368 |
2,293 |
$6K |
| C9399 |
Unclassified drugs or biolog |
66 |
63 |
$975.60 |
| 81025 |
|
643 |
622 |
$647.17 |
| J7999 |
Compounded drug, noc |
109 |
75 |
$551.34 |
| 82962 |
|
374 |
317 |
$391.10 |
| J0690 |
Cefazolin sodium injection |
2,466 |
1,975 |
$357.41 |
| S0020 |
Injection, bupivicaine hydro |
663 |
619 |
$298.19 |
| J3010 |
Fentanyl citrate injection |
4,500 |
3,691 |
$256.51 |
| 85610 |
|
74 |
65 |
$104.36 |
| J1170 |
Hydromorphone injection |
634 |
527 |
$101.75 |
| J0171 |
Adrenalin epinephrine inject |
15 |
14 |
$96.00 |
| J1100 |
Dexamethasone sodium phos |
1,915 |
1,808 |
$79.38 |
| 88304 |
|
63 |
62 |
$68.90 |
| 85025 |
|
30 |
27 |
$54.54 |
| 85730 |
|
32 |
26 |
$50.25 |
| J2250 |
Inj midazolam hydrochloride |
2,742 |
2,624 |
$49.63 |
| J2405 |
Ondansetron hcl injection |
2,215 |
2,044 |
$49.04 |
| J1885 |
Ketorolac tromethamine inj |
948 |
899 |
$45.85 |
| 88307 |
|
29 |
26 |
$25.40 |
| Q9966 |
Locm 200-299mg/ml iodine,1ml |
12 |
12 |
$16.00 |
| J2704 |
Inj, propofol, 10 mg |
849 |
686 |
$11.51 |
| J2270 |
Morphine sulfate injection |
42 |
40 |
$9.45 |
| J1644 |
Inj heparin sodium per 1000u |
50 |
38 |
$2.10 |
| J0665 |
Inj, bupivacaine, nos, 0.5mg |
512 |
489 |
$0.00 |
| J1596 |
Inj, glycopyrrolate, 0.1 mg |
90 |
85 |
$0.00 |
| J0694 |
Cefoxitin sodium injection |
110 |
105 |
$0.00 |
| J1171 |
Inj, hydromorphone, 0.1 mg |
15 |
14 |
$0.00 |
| S0028 |
Injection, famotidine, 20 mg |
94 |
90 |
$0.00 |
| J7120 |
Ringers lactate infusion |
14 |
14 |
$0.00 |
| J3370 |
Vancomycin hcl injection |
13 |
12 |
$0.00 |
| J0131 |
Inj, acetaminophen (nos) |
55 |
50 |
$0.00 |