| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 00170 |
Anesthesia for intraoral procedures, including biopsy |
33 |
14 |
$646.91 |
| E0439 |
Stationary liquid oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, & tubing |
33 |
14 |
$0.00 |
| J2704 |
Injection, propofol, 10 mg |
33 |
14 |
$0.00 |
| J3490 |
Unclassified drugs |
33 |
14 |
$0.00 |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
33 |
14 |
$0.00 |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
33 |
14 |
$0.00 |
| J7699 |
Noc drugs, inhalation solution administered through dme |
33 |
14 |
$0.00 |
| 99199 |
Unlisted special service, procedure or report |
33 |
14 |
$0.00 |
| J7120 |
Ringers lactate infusion, up to 1000 cc |
33 |
14 |
$0.00 |