| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 96375 |
|
178 |
54 |
$3K |
| 96372 |
|
258 |
161 |
$3K |
| 97140 |
|
480 |
214 |
$3K |
| 99215 |
Prolong outpt/office vis |
336 |
266 |
$3K |
| 99211 |
|
265 |
99 |
$2K |
| 96374 |
|
178 |
54 |
$1K |
| 99213 |
|
673 |
300 |
$1K |
| 96365 |
|
177 |
54 |
$1K |
| J3490 |
Unclassified drugs |
139 |
25 |
$1K |
| 97811 |
|
112 |
66 |
$1K |
| 99214 |
|
219 |
161 |
$753.49 |
| 97810 |
|
158 |
90 |
$641.83 |
| A4208 |
Syringe with needle, sterile 3 cc, each |
217 |
85 |
$578.98 |
| J3415 |
Injection, pyridoxine hcl, 100 mg |
227 |
123 |
$394.07 |
| J3420 |
Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg |
406 |
175 |
$211.43 |
| J0610 |
Injection, calcium gluconate (fresenius kabi), per 10 ml |
79 |
24 |
$198.28 |
| 97530 |
|
206 |
124 |
$182.78 |
| 97026 |
|
142 |
75 |
$120.45 |
| 96367 |
|
64 |
12 |
$105.29 |
| 97032 |
|
32 |
12 |
$15.59 |
| J7040 |
Infusion, normal saline solution, sterile (500 ml = 1 unit) |
49 |
14 |
$12.76 |
| J3475 |
Injection, magnesium sulfate, per 500 mg |
43 |
13 |
$11.23 |
| J2001 |
Injection, lidocaine hcl for intravenous infusion, 10 mg |
34 |
25 |
$0.45 |