| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| U0003 |
Cov-19 amp prb hgh thruput |
75 |
65 |
$5K |
| 85025 |
|
503 |
410 |
$3K |
| 87426 |
|
80 |
69 |
$3K |
| 81025 |
|
99 |
86 |
$510.44 |
| 87804 |
|
45 |
21 |
$480.02 |
| 93970 |
|
18 |
12 |
$422.90 |
| J2405 |
Ondansetron hcl injection |
606 |
532 |
$370.78 |
| J2250 |
Inj midazolam hydrochloride |
665 |
595 |
$160.74 |
| J2001 |
Lidocaine injection |
640 |
580 |
$140.69 |
| J1885 |
Ketorolac tromethamine inj |
312 |
277 |
$105.16 |
| 80048 |
|
14 |
13 |
$96.71 |
| J2704 |
Inj, propofol, 10 mg |
684 |
618 |
$57.56 |
| J3010 |
Fentanyl citrate injection |
593 |
538 |
$42.18 |
| J0690 |
Cefazolin sodium injection |
424 |
377 |
$29.93 |
| J1100 |
Dexamethasone sodium phos |
18 |
15 |
$17.51 |
| C9803 |
Hopd covid-19 spec collect |
57 |
48 |
$4.15 |
| 87635 |
|
26 |
24 |
$0.00 |
| J1170 |
Hydromorphone injection |
17 |
12 |
$0.00 |
| J1040 |
Methylprednisolone 80 mg inj |
13 |
13 |
$0.00 |