| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 66984 |
|
22 |
14 |
$24K |
| 97110 |
|
21 |
12 |
$372.93 |
| 97535 |
|
21 |
12 |
$372.93 |
| 97116 |
|
20 |
12 |
$0.00 |
| C1713 |
Anchor/screw bn/bn,tis/bn |
15 |
12 |
$0.00 |
| C1776 |
Joint device (implantable) |
15 |
12 |
$0.00 |
| J3370 |
Vancomycin hcl injection |
15 |
12 |
$0.00 |
| J2795 |
Ropivacaine hcl injection |
15 |
12 |
$0.00 |
| J2370 |
Phenylephrine hcl injection |
61 |
39 |
$0.00 |
| J2250 |
Inj midazolam hydrochloride |
15 |
12 |
$0.00 |
| V2632 |
Post chmbr intraocular lens |
59 |
38 |
$0.00 |
| J0690 |
Cefazolin sodium injection |
28 |
12 |
$0.00 |
| J2704 |
Inj, propofol, 10 mg |
15 |
12 |
$0.00 |
| G0378 |
Hospital observation per hr |
15 |
12 |
$0.00 |