| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 43239 |
|
70 |
69 |
$13K |
| J1170 |
Hydromorphone injection |
683 |
556 |
$1K |
| 88305 |
|
355 |
352 |
$1K |
| 84703 |
|
240 |
234 |
$524.68 |
| J2704 |
Inj, propofol, 10 mg |
2,776 |
2,642 |
$403.28 |
| J2250 |
Inj midazolam hydrochloride |
1,892 |
1,831 |
$303.25 |
| J1100 |
Dexamethasone sodium phos |
1,320 |
1,291 |
$302.28 |
| J3010 |
Fentanyl citrate injection |
1,847 |
1,749 |
$285.07 |
| 82947 |
|
254 |
248 |
$229.32 |
| 88307 |
|
13 |
13 |
$221.95 |
| J7120 |
Ringers lactate infusion |
2,317 |
2,251 |
$178.88 |
| J2405 |
Ondansetron hcl injection |
1,765 |
1,619 |
$156.03 |
| J2710 |
Neostigmine methylslfte inj |
30 |
29 |
$101.63 |
| 81025 |
|
48 |
47 |
$60.80 |
| 82948 |
|
88 |
87 |
$43.80 |
| 82962 |
|
51 |
50 |
$40.80 |
| J1885 |
Ketorolac tromethamine inj |
375 |
368 |
$39.68 |
| J7030 |
Normal saline solution infus |
197 |
196 |
$0.00 |
| J0665 |
Inj, bupivacaine, nos, 0.5mg |
188 |
183 |
$0.00 |
| J1596 |
Inj, glycopyrrolate, 0.1 mg |
284 |
275 |
$0.00 |
| J1171 |
Inj, hydromorphone, 0.1 mg |
43 |
35 |
$0.00 |
| J0690 |
Cefazolin sodium injection |
100 |
98 |
$0.00 |
| J2003 |
Inj, lidocaine hcl, 1 mg |
93 |
85 |
$0.00 |
| J0330 |
Succinycholine chloride inj |
12 |
12 |
$0.00 |