| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 69436 |
|
413 |
337 |
$447K |
| 42820 |
|
80 |
68 |
$289K |
| 88304 |
|
610 |
332 |
$19K |
| 88305 |
|
268 |
176 |
$6K |
| 43239 |
|
14 |
12 |
$2K |
| J0461 |
Atropine sulfate injection |
547 |
416 |
$42.24 |
| 82948 |
|
26 |
25 |
$36.68 |
| J3010 |
Fentanyl citrate injection |
946 |
695 |
$25.43 |
| J1100 |
Dexamethasone sodium phos |
675 |
520 |
$16.74 |
| J2405 |
Ondansetron hcl injection |
677 |
523 |
$6.55 |
| J0690 |
Cefazolin sodium injection |
159 |
116 |
$0.00 |
| J0330 |
Succinycholine chloride inj |
136 |
111 |
$0.00 |
| J1030 |
Methylprednisolone 40 mg inj |
18 |
14 |
$0.00 |
| J3490 |
Drugs unclassified injection |
2,741 |
753 |
$0.00 |
| J2175 |
Meperidine hydrochl /100 mg |
61 |
50 |
$0.00 |
| J2704 |
Inj, propofol, 10 mg |
530 |
458 |
$0.00 |
| 36416 |
|
26 |
25 |
$0.00 |
| J2001 |
Lidocaine injection |
19 |
12 |
$0.00 |
| J2003 |
Inj, lidocaine hcl, 1 mg |
30 |
19 |
$0.00 |
| J1040 |
Methylprednisolone 80 mg inj |
14 |
13 |
$0.00 |
| J0171 |
Adrenalin epinephrine inject |
63 |
47 |
$0.00 |
| J2004 |
Inj, lidocaine w epinephrine |
13 |
13 |
$0.00 |