| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99283 |
|
2,729 |
2,538 |
$337K |
| 97110 |
|
3,133 |
886 |
$204K |
| 99284 |
|
816 |
768 |
$117K |
| 73721 |
|
389 |
354 |
$102K |
| 99282 |
|
83 |
80 |
$6K |
| 96361 |
|
16 |
14 |
$5K |
| J3490 |
Drugs unclassified injection |
5,607 |
1,654 |
$4K |
| 73221 |
|
16 |
14 |
$4K |
| 71046 |
|
96 |
88 |
$2K |
| 97530 |
|
24 |
12 |
$2K |
| J2704 |
Inj, propofol, 10 mg |
845 |
713 |
$1K |
| 85025 |
|
682 |
623 |
$1K |
| 80053 |
|
546 |
507 |
$945.72 |
| 99285 |
|
13 |
12 |
$698.02 |
| 97161 |
|
91 |
81 |
$552.56 |
| Q0162 |
Ondansetron oral |
14 |
14 |
$461.93 |
| 81025 |
|
345 |
320 |
$451.09 |
| 87880 |
|
39 |
36 |
$233.01 |
| J3010 |
Fentanyl citrate injection |
1,026 |
641 |
$202.33 |
| 87804 |
|
12 |
12 |
$198.60 |
| 76942 |
|
257 |
220 |
$166.32 |
| J2405 |
Ondansetron hcl injection |
1,058 |
880 |
$123.23 |
| J1100 |
Dexamethasone sodium phos |
755 |
686 |
$93.79 |
| J0690 |
Cefazolin sodium injection |
717 |
560 |
$75.11 |
| J2250 |
Inj midazolam hydrochloride |
460 |
396 |
$32.16 |
| 96372 |
|
69 |
52 |
$0.00 |
| 81001 |
|
17 |
16 |
$0.00 |
| J2001 |
Lidocaine injection |
634 |
510 |
$0.00 |
| 96374 |
|
112 |
103 |
$0.00 |
| J1885 |
Ketorolac tromethamine inj |
146 |
126 |
$0.00 |
| 96375 |
|
12 |
12 |
$0.00 |
| J0131 |
Inj, acetaminophen (nos) |
16 |
13 |
$0.00 |
| J7040 |
Normal saline solution infus |
87 |
72 |
$0.00 |
| J8499 |
Oral prescrip drug non chemo |
285 |
192 |
$0.00 |
| G1004 |
Cdsm ndsc |
387 |
354 |
$0.00 |
| 93005 |
|
47 |
38 |
$0.00 |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
19 |
17 |
$0.00 |
| C1713 |
Anchor/screw bn/bn,tis/bn |
16 |
13 |
$0.00 |