| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 36415 |
|
389 |
382 |
$38K |
| 93005 |
|
486 |
481 |
$19K |
| 29848 |
|
25 |
24 |
$10K |
| D2930 |
|
37 |
37 |
$9K |
| 66984 |
|
42 |
41 |
$5K |
| 81025 |
|
25 |
24 |
$2K |
| 76000 |
|
131 |
128 |
$357.48 |
| J7120 |
Ringers lactate infusion |
4,257 |
4,139 |
$211.45 |
| 86850 |
|
56 |
56 |
$69.61 |
| J0690 |
Cefazolin sodium injection |
932 |
904 |
$39.26 |
| J1885 |
Ketorolac tromethamine inj |
251 |
251 |
$7.39 |
| J2405 |
Ondansetron hcl injection |
1,241 |
1,199 |
$0.00 |
| J7030 |
Normal saline solution infus |
14 |
14 |
$0.00 |
| 86900 |
|
56 |
56 |
$0.00 |
| J0665 |
Inj, bupivacaine, nos, 0.5mg |
484 |
334 |
$0.00 |
| J0735 |
Clonidine hydrochloride |
13 |
13 |
$0.00 |
| D1120 |
|
24 |
24 |
$0.00 |
| 86901 |
|
56 |
56 |
$0.00 |
| J2001 |
Lidocaine injection |
650 |
630 |
$0.00 |
| J2250 |
Inj midazolam hydrochloride |
2,971 |
2,773 |
$0.00 |
| J3010 |
Fentanyl citrate injection |
3,260 |
3,165 |
$0.00 |
| J3490 |
Drugs unclassified injection |
1,624 |
1,422 |
$0.00 |
| 85025 |
|
81 |
79 |
$0.00 |
| 80048 |
|
105 |
102 |
$0.00 |
| V2632 |
Post chmbr intraocular lens |
70 |
67 |
$0.00 |
| 64721 |
|
29 |
28 |
$0.00 |
| J1100 |
Dexamethasone sodium phos |
582 |
574 |
$0.00 |
| 85027 |
|
79 |
79 |
$0.00 |
| J2795 |
Ropivacaine hcl injection |
56 |
56 |
$0.00 |
| J2003 |
Inj, lidocaine hcl, 1 mg |
45 |
41 |
$0.00 |